Dataset Information

Acute Stroke Care in Korea in 2013-2014: National Averages and Disparities.

ABSTRACT: BACKGROUND:This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions. METHODS:The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected. RESULTS:A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic stroke; 15%, intracerebral hemorrhage (ICH); and 9%, subarachnoid hemorrhage (SAH). Of the hospitals, 31% provided inpatient stroke unit care. Ambulances were used in 56% of cases, and the median interval from onset to arrival was 4.5 hours. One-quarter of patients were referred from other hospitals. Intravenous thrombolysis (IVT) and endovascular treatment (EVT) rates were 11% and 4%, respectively. Three-quarters of the analyzed hospitals provided IVT and/or EVT, whereas 47% of hospitals providing IVT and 67% of hospitals providing EVT had less than one case per month. Decompressive surgery was performed on 28% of ICH patients, and clipping and coiling were performed in 17.2% and 14.3% of SAH patients, respectively. There were noticeable regional disparities between the various interventions, ambulance use, arrival time, and stroke unit availability. CONCLUSION:This study describes the current status of acute stroke care in Korea. Despite quite acceptable quality of stroke care, it suggests regional and hospital disparities. Expansion of stroke units, stroke center certification or accreditation, and connections between stroke centers and emergency medical services are highly recommended.

SUBMITTER: Kim JY

PROVIDER: S-EPMC7246192 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Acute Stroke Care in Korea in 2013-2014: National Averages and Disparities.

Kim Jun Yup JY Lee Keon Joo KJ Kang Jihoon J Kim Beom Joon BJ Kim Seong Eun SE Oh Hyunji H Park Hong Kyun HK Cho Yong Jin YJ Park Jong Moo JM Park Kwang Yeol KY Lee Kyung Bok KB Lee Soo Joo SJ Kim Tackeun T Lee Ji Sung JS Lee Juneyoung J Yang Ki Hwa KH Choi Ah Rum AR Kang Mi Yeon MY Bae Hee Joon HJ

Journal of Korean medical science 20200525 20

<h4>Background</h4>This study aimed to describe the current status of acute stroke care in Korea and explore disparities among hospitals and regions.<h4>Methods</h4>The 2013 and 2014 national stroke audit data and the national health insurance claims data were linked and used for this study. Stroke patients hospitalized via emergency rooms within 7 days of stroke onset were selected.<h4>Results</h4>A total of 19,608 patients treated in 216 hospitals were analyzed. Among them 76% had ischemic str ...[more]

PMID: 32449325

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Project description:Racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race-ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines-Stroke hospitals.Seventy-five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010-2014). Logistic regression models examined racial-ethnic differences in acute stroke performance measures and defect-free care (intravenous tissue plasminogen activator treatment, in-hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non-Hispanic white (NHW), 18% were non-Hispanic black (NHB), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico. NHW patients were the oldest, followed by Hispanics, and NHBs. Defect-free care was greatest among NHBs (81%), followed by NHWs (79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (P<0.0001). Puerto Rico Hispanics were less likely than Florida whites to meet any stroke care performance metric other than anticoagulation. Defect-free care improved for all groups during 2010-2014, but the disparity in Puerto Rico persisted (2010: NHWs=63%, NHBs=65%, Florida Hispanics=59%, Puerto Rico Hispanics=31%; 2014: NHWs=93%, NHBs=94%, Florida Hispanics=94%, Puerto Rico Hispanics=63%).Racial-ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial-ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence-based acute stroke quality improvement programs is required to improve stroke care and minimize racial-ethnic disparities, particularly in resource-strained Puerto Rico.

Dataset Information

Acute Stroke Care in Korea in 2013-2014: National Averages and Disparities.

Publications

Acute Stroke Care in Korea in 2013-2014: National Averages and Disparities.

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