Public Reporting on the Quality of Care in Patients with Acute Myocardial Infarction: The Korean Experience
Abstract
:1. Introduction
2. Methods
2.1. Data Sources
2.2. Study Population
2.3. Indicators
2.4. Statistical Analysis
3. Results
3.1. Characteristics of Patients and Hospitals
3.2. Process Indicators
3.3. Outcome Indicators
4. Discussion
4.1. Key Findings
4.2. Interpretation within the Context of the Wider Literature
4.3. Implications for Policy, Practice and Research
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Variables | Numerator | Denominator (Case of Population) |
---|---|---|
Population | ||
Source population | No. of patients identified from claim data | |
Eligible patients | No. of patients diagnosed with AMI | |
Exclude | No. of excluded patients | |
Male patients | No. of male patients | |
Age | Mean, SD of patients | |
Age of males | Mean, SD of male patients | |
Age of females | Mean, SD of female patients | |
STEMI 1 patients | ST elevation on ECG or new onset LBBB | |
Patients treated with reperfusion | No. of patients exposed to reperfusion | |
Reperfusion of STEMI patients | No. of STEMI patients treated with reperfusion | |
Reperfusion of NSTEMI 2 patients | No. of NSTEMI patients treated with reperfusion | |
Monthly patients | Monthly number of patients | |
Monthly number of STEMI patients | Monthly number of STEMI patients | |
Monthly number of non-STEMI patients | Monthly number of NSTEMI patients | |
Process | ||
Timely reperfusion rate (A = A1 + A2) | STEMI | |
Thrombolytic rate within 30 min (A1) | within 30 min of arrival (from 2010 to 2012)within 60 min of arrival (from 2007 to 2009) | Thrombolytic therapy within 6 h of hospital arrival of STEMI |
P.PCI rate within 90 min (A2) | within 90 min of arrival (from2010 to 2012)within 120 min of arrival (from 2007 to 2009) | P.PCI within 12 h of hospital arrival of STEMI |
Oral medication (B = B1 + B2 + B3) | Eligible | |
Aspirin at arrival (B1) | Aspirin administered within 24 h of hospital arrival | |
Aspirin prescribed at discharge (B2) | prescribed at discharge | |
Beta-blocker prescribed at discharge (B3) | prescribed at discharge | |
Ambulance utilization rate | No. of patients hospitalized by ambulance | Eligible |
Symptom-to-door (S2D) median time (minutes) | Symptom-to-door median time (minutes) | Eligible |
Door-to-thrombolytic(D2T) median time (minutes) | Door to thrombolytic (D2T) median time (minutes) | STEMI |
Door-to-P.PCI balloon inflation (D2B) median time (minutes) | Door-to-P.PCI balloon inflation (D2B) median time (minutes) | STEMI |
Outcomes | ||
30-day mortality rate following admission | No. of patients who died within 30 days of hospitalization | Eligible |
In-hospital mortality rate | No. of patients who died during hospitalization | |
Monthly 30-days mortality rate from admission | Number of patients dying within 30 days of hospitalization | Eligible |
1-year mortality following symptoms | Number of patients dying within 1 year of symptom manifestation |
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Characteristics | Total | Year | Hospital Type | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | p | Tertiary Hospitals | General Hospitals | p | ||
No. of Source patients | 128,327 | 8633 | 17,087 | 19,035 | 34,321 | 24,984 | 24,267 | 67,646 | 60,681 | ||
Exclude, No. (%) | 44,949 (35.0) | 4433 (51.3) | 5431 (31.8) | 3259 (17.1) | 17,866 (52.1) | 7722 (30.9) | 6238 (25.7) | 17,185 (25.4) | 27,764 (45.8) | ||
No. of Eligible patients, No. (%) | 83,378 (65.0) | 4200 (48.7) | 11,656 (68.2) | 15,776 (82.9) | 16,455 (47.9) | 17,262 (69.1) | 18,029 (74.3) | 50,461 (60.5) | 32,917 (39.5) | ||
Demographic factors | |||||||||||
Age, Mean (SD), year | 64.4 (13.2) | 64.2 (13.2) | 64.5 (13.2) | 64.2 (13.2) | 64.5 (13.3) | 64.3 (13.2) | 0.130 | 64.4 (13.0) | 64.3 (13.5) | 0.179 | |
Male, No. (%) | 55,178 (69.7) | 8028 (68.9) | 10,806 (68.5) | 11,435 (69.5) | 12,091 (70.0) | 12,818 (71.1) | <0.001 | 32,574 (70.4) | 22,845 (69.4) | 0.002 | |
STEMI 1 Group | |||||||||||
STEMI 1 | 43,240 (51.9) | 2242 (53.4) | 6184 (53.1) | 8279 (52.5) | 8570 (52.1) | 8896 (51.5) | 9069 (50.3) | <0.001 | 25,031 (57.9) | 18,209 (42.1) | <0.001 |
NSTEMI 2 | 40,138 (48.1) | 1958 (46.6) | 5472 (46.9) | 7497 (47.5) | 7885 (47.9) | 8366 (48.5) | 8960 (49.7) | 25,430 (63.4) | 14,708 (36.6) | ||
Hospitals | |||||||||||
Participants hospitals, No. (%) | 1005 | 43 | 195 | 211 | 189 | 181 | 186 | 261 (26.0) | 744 (74.0) | ||
Patients by hospital, Mean (SD) | 83 (106.6) | 97.7 (61.1) | 59.8 (98.8) | 74.8 (106.2) | 87.1 (105.8) | 95.4 (111.3) | 96.9 (115.2) | 0.004 | 193.3 (130.5) | 44.2 (60.1) | <0.001 |
Process | |||||||||||
Reperfusion patients, No. (%) | 70,738 (84.8) | 3410 (81.2) | 9484 (81.4) | 13,012 (82.5) | 13,967 (84.9) | 15,029 (87.1) | 15,836 (87.8) | <0.001 | 43,086 (85.4) | 27,652 (84.0) | <0.001 |
STEMI 1 patients | 40,609 (93.9) | 2016 (89.9) | 5618 (90.8) | 7639 (92.3) | 8083 (94.3) | 8508 (95.6) | 8745 (96.4) | <0.001 | 23,681 (94.6) | 16,928 (93.0) | <0.001 |
NSTEMI 2 patients | 30,129 (75.1) | 1394 (71.2) | 3866 (70.7) | 5373 (71.7) | 5884 (74.6) | 6521 (77.9) | 7091 (79.1) | <0.001 | 19,405 (76.3) | 10,724 (72.9) | <0.001 |
Ambulance utilization, No. (%) | 35,791 (51.5) | 648 (35.8) | 3738 (46.6) | 7075 (51.3) | 7441 (51.5) | 8226 (53.6) | 8663 (53.8) | <0.001 | 20,917 (52.3) | 14,874 (50.3) | <0.001 |
Symptoms to door time, Median (IQR), minute | 151 (286.0) | 125 (318.0) | 156 (298.0) | 164 (290.0) | 156 (289.0) | 150 (278.0) | 141 (273.0) | <0.001 | 165 (286.0) | 134 (274.0) | <0.001 |
Door to Thrombolytic time, Median (IQR), minute | 29 (28.0) | 48 (45.0) | 42 (35.0) | 40 (33.0) | 27 (16.0) | 27 (7.0) | 27 (6.0) | <0.001 | 29 (23.0) | 30 (38.0) | 0.018 |
Door to P.PCI balloon inflation time, Median (IQR), minute | 69 (36.0) | 89 (92.5) | 84 (64.0) | 77 (48.0) | 68 (34.0) | 63 (31.0) | 61 (30.0) | <0.001 | 68 (36.0) | 70(36.0) | 0.001 |
Outcomes | |||||||||||
30-days mortality from admission, No. (%) | 5211 (7.7) | 139 (7.9) | 668 (8.6) | 1029 (7.7) | 1113 (7.9) | 1157 (7.7) | 1105 (7.0) | <0.001 | 2698 (6.9) | 2522 (8.8) | <0.001 |
Indicators | Year | Linear Regression by Year | |||||||
---|---|---|---|---|---|---|---|---|---|
2007 | 2008 | 2009 | 2010 | 2011 | 2012 | Estimate (β) | (95% CI) | p | |
Reperfusion rate | |||||||||
All patients | 81.2 | 81.4 | 82.5 | 84.9 | 87.1 | 87.8 | 1.50 | (1.01, 1.99) | 0.001 |
Tertiary hospitals | 81.2 | 81.9 | 84.2 | 86.2 | 87.9 | 88 | 1.55 | (1.11, 2.00) | 0.001 |
General hospitals | 79.9 | 80.1 | 83.2 | 85.9 | 87.6 | 2.12 | (1.26, 2.98) | 0.004 | |
Reperfusion rate of STEMI 1 | |||||||||
All patients | 89.9 | 90.8 | 92.3 | 94.3 | 95.6 | 96.4 | 1.40 | (1.16, 1.63) | <0.001 |
Tertiary hospitals | 89.9 | 91.8 | 94 | 95.6 | 96.6 | 97.1 | 1.49 | (1.05, 1.93) | 0.001 |
General hospitals | 88.6 | 90.1 | 92.8 | 94.5 | 95.7 | 1.85 | (1.41, 2.29) | 0.001 | |
Reperfusion rate of NSTEMI 2 | |||||||||
All patients | 71.2 | 70.7 | 71.7 | 74.6 | 77.9 | 79.1 | 1.83 | (0.96, 2.70) | 0.004 |
Tertiary hospitals | 71.2 | 71.5 | 74.3 | 77 | 79.7 | 80 | 2.04 | (1.42, 2.66) | 0.001 |
General hospitals | 68.1 | 67.7 | 71.1 | 75.4 | 78 | 2.76 | (1.29, 4.23) | 0.009 | |
Timely Reperfusion rate | |||||||||
All patients | 82.9 | 86.1 | 90.9 | 90.6 | 95.3 | 96.9 | 2.78 | (1.97, 3.59) | 0.001 |
Tertiary hospitals | 82.9 | 88.7 | 95.7 | 95.5 | 98.5 | 99.2 | 3.16 | (1.45, 4.48) | 0.011 |
General hospitals | 81.3 | 84.8 | 84.9 | 91.8 | 94.6 | 3.36 | (1.67, 5.05) | 0.008 | |
Thrombolytic rate within 30 min | |||||||||
All patients | 70.3 | 79.7 | 81.9 | 79.9 | 88.4 | 90 | 3.50 | (1.50, 5.50) | 0.008 |
Tertiary hospitals | 70.3 | 86.4 | 91.2 | 93.3 | 97.3 | 96.6 | 3.92 | (1.67, 6.17) | 0.008 |
General hospitals | 69 | 71.5 | 61.9 | 79.6 | 84.2 | 3.85 | (−3.54,11.24) | 0.196 | |
P.PCI 3 rate within 90 min | |||||||||
All patients | 85.3 | 86.9 | 91.7 | 91.2 | 95.7 | 97.3 | 2.45 | (1.68, 3.23) | 0.001 |
Tertiary hospitals | 85.3 | 88.9 | 96 | 95.7 | 98.6 | 99.3 | 2.82 | (1.4, 4.24) | 0.005 |
General hospitals | 83 | 86 | 86.1 | 92.6 | 95.2 | 3.1 | (1.47, 4.72) | 0.009 | |
Oral Medication rate | |||||||||
All patients | 98.2 | 97.9 | 98 | 98.8 | 99.4 | 99.6 | 0.35 | (0.11, 0.59) | 0.015 |
Tertiary hospitals | 98.2 | 98.7 | 99.3 | 99.7 | 99.8 | 99.9 | 0.35 | (0.19, 0.50) | 0.003 |
General hospitals | 95.9 | 96.1 | 97.7 | 98.8 | 99.1 | 0.91 | (0.49, 1.33) | 0.006 | |
Aspirin at arrival rate | |||||||||
All patients | 98 | 98.1 | 98.6 | 99.1 | 99.6 | 99.4 | 0.34 | (0.19, 0.49) | 0.003 |
Tertiary hospitals | 98 | 98.8 | 99.7 | 99.8 | 99.9 | 100 | 0.38 | (0.12, 0.64) | 0.015 |
General hospitals | 96.6 | 97.2 | 98.3 | 99.2 | 98.9 | 0.66 | (0.22, 1.10) | 0.018 | |
Aspirin prescribed at discharge | |||||||||
All patients | 99.5 | 99.4 | 99.3 | 99.6 | 99.6 | 99.8 | 0.07 | (−0.02, 0.16) | 0.098 |
Tertiary hospitals | 99.5 | 99.6 | 99.6 | 99.9 | 99.8 | 99.9 | 0.08 | (0.03, 0.14) | 0.014 |
General hospitals | 98.9 | 98.9 | 99.1 | 99.3 | 99.6 | 0.18 | (0.08, 0.28) | 0.010 | |
Beta-blocker prescribed at discharge | |||||||||
All patients | 96.1 | 96 | 95.7 | 97.7 | 98.8 | 99.5 | 0.78 | (0.29, 1.28) | 0.012 |
Tertiary hospitals | 96.1 | 97.7 | 98.7 | 99.3 | 99.6 | 99.9 | 0.72 | (0.38, 1.07) | 0.004 |
General hospitals | 91.1 | 91.3 | 95.4 | 97.8 | 98.9 | 2.21 | (1.18, 3.25) | 0.007 | |
30-days mortality rate from admission | |||||||||
All patients | 7.9 | 8.6 | 7.7 | 7.9 | 7.7 | 7.0 | −0.20 | (−0.46, 0.06) | 0.101 |
Tertiary hospitals | 7.9 | 8.2 | 6.4 | 7.1 | 6.8 | 6.1 | −0.36 | (−0.72, 0.01) | 0.050 |
General hospitals | 9.4 | 9.6 | 9.0 | 8.8 | 8.0 | −0.36 | (−0.65, −0.07) | 0.030 | |
Ambulance utilization rate | |||||||||
All patients | 35.8 | 46.6 | 51.3 | 51.5 | 53.6 | 53.8 | |||
Tertiary hospitals | 35.8 | 46.8 | 52.4 | 52.5 | 55.9 | 55.7 | |||
General hospitals | 46 | 50 | 50.2 | 50.9 | 51.6 | ||||
Symptoms to door Median time (minute) | |||||||||
All patients | 125 | 156 | 164 | 156 | 148 | 140 | |||
Tertiary hospitals | 125 | 163 | 176 | 173 | 162 | 158 | |||
General hospitals | 139 | 145 | 135 | 131 | 121 | ||||
Door to Thrombolytic Median Time (minute) | |||||||||
All patients | 49.5 | 46 | 40 | 27 | 27 | 27 | |||
Tertiary hospitals | 50 | 38 | 33 | 26 | 26 | 27 | |||
General hospitals | 54 | 48 | 29 | 27 | 26 | ||||
Door to P.PCI balloon inflation Median Time (minute) | |||||||||
All patients | 106.5 | 85 | 76 | 67 | 62 | 61 | |||
Tertiary hospitals | 107 | 82 | 72 | 65 | 60 | 60 | |||
General hospitals | 88 | 81 | 70 | 65 | 63 |
Type | No | Regession for Observation by Time (Year Month) | Regession for ARIMA 1 Model by Time (Year Month) | |||||
---|---|---|---|---|---|---|---|---|
No. of Cases | Estimate (β) | (95% CI) | p Value | Estimate (β) | (95% CI) | p Value | ||
30-day mortality rate from admission | ||||||||
Total | ||||||||
All | 67,191 | 5511 | −0.00093 | (−0.00155, −0.00031) | 0.004 | −0.00140 | (−0.00187, −0.00093) | <0.001 |
STEMI 2 | 34,653 | 2966 | −0.00032 | (−0.00105, 0.00041) | 0.385 | −0.00005 | (−0.00064, 0.00053) | 0.859 |
NSTEMI 3 | 32,538 | 2545 | −0.00152 | (−0.00242, −0.00062) | 0.001 | −0.00136 | (−0.00216, −0.00057) | 0.001 |
Distribution of NSTEMI 3 patients | 67,191 | 32,538 | 0.00176 | (0.00065, 0.00288) | 0.003 | 0.00145 | (0.00067, 0.00224) | 0.001 |
Tertiary Hospitals | ||||||||
All | 37,595 | 2742 | −0.00051 | (−0.00129, 0.00028) | 0.202 | 0.00000 | (−0.00062, 0.00062) | 0.999 |
STEMI 2 | 18,378 | 1493 | 0.00035 | (−0.00071, 0.00141) | 0.508 | 0.00075 | (−0.00003, 0.00153) | 0.061 |
NSTEMI 3 | 19,247 | 1249 | −0.00118 | (−0.00223, −0.00013) | 0.029 | −0.00075 | (−0.00159, 0.00009) | 0.081 |
Distribution of NSTEMI 3 patients | 37,595 | 19,247 | 0.00288 | (0.00149, 0.00427) | <0.001 | 0.00263 | (0.00173, 0.00353) | <0.001 |
General Hospitals | ||||||||
All | 29,596 | 2769 | −0.00164 | (−0.00240, −0.00088) | <0.001 | −0.00158 | (−0.00229, −0.00088) | <0.001 |
STEMI 2 | 16,305 | 1473 | −0.00119 | (−0.00216, −0.00021) | 0.018 | −0.00105 | (−0.00189, −0.00020) | 0.017 |
NSTEMI 3 | 13,291 | 1296 | −0.00221 | (−0.00351, −0.00091) | 0.001 | −0.00218 | (−0.00343, −0.00094) | 0.001 |
Distribution of NSTEMI 3 patients | 29,596 | 13,291 | 0.00077 | (−0.00065, 0.00219) | 0.286 | 0.00046 | (−0.00069, 0.00161) | 0.427 |
1-year mortality rate from Symptoms | ||||||||
Total | ||||||||
All | 67,191 | 9396 | −0.00002 | (−0.00003, −0.00001) | 0.002 | −0.00001 | (−0.00002, 0.00000) | 0.007 |
STEMI 2 | 34,653 | 4379 | −0.00001 | (−0.00002, 0.00000) | 0.073 | −0.00001 | (−0.00002, 0.00000) | 0.237 |
NSTEMI 3 | 32,538 | 5017 | −0.00003 | (−0.00004, −0.00001) | <0.001 | −0.00002 | (−0.00003, −0.00001) | 0.001 |
Tertiary Hospitals | ||||||||
All | 37,595 | 4938 | −0.00001 | (−0.00002, 0.00000) | 0.046 | −0.00001 | (−0.00002, 0.00000) | 0.243 |
STEMI 2 | 18,378 | 2253 | 0.00000 | (−0.00002, 0.00001) | 0.520 | 0.00000 | (−0.00001, 0.00001) | 0.903 |
NSTEMI 3 | 19,247 | 2685 | −0.00002 | (−0.00003, 0.00000) | 0.010 | −0.00001 | (−0.00002, 0.00000) | 0.061 |
General Hospitals | ||||||||
All | 29,596 | 4458 | −0.00003 | (−0.00004, −0.00001) | <0.001 | −0.00002 | (−0.00004, −0.00001) | <0.001 |
STEMI 2 | 16,305 | 2126 | −0.00002 | (−0.00003, 0.00000) | 0.016 | −0.00001 | (−0.00003, 0.00000) | 0.034 |
NSTEMI 3 | 13,291 | 2332 | −0.00004 | (−0.00006, −0.00002) | <0.001 | −0.00004 | (−0.00005, −0.00002) | <0.001 |
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Chae, K.; Kim, M.; Kim, B.O.; Jung, C.Y.; Kang, H.-J.; Oh, D.-J.; Jeon, D.W.; Chung, W.-Y.; Choi, C.U.; Han, K.-R.; et al. Public Reporting on the Quality of Care in Patients with Acute Myocardial Infarction: The Korean Experience. Int. J. Environ. Res. Public Health 2022, 19, 3169. https://doi.org/10.3390/ijerph19063169
Chae K, Kim M, Kim BO, Jung CY, Kang H-J, Oh D-J, Jeon DW, Chung W-Y, Choi CU, Han K-R, et al. Public Reporting on the Quality of Care in Patients with Acute Myocardial Infarction: The Korean Experience. International Journal of Environmental Research and Public Health. 2022; 19(6):3169. https://doi.org/10.3390/ijerph19063169
Chicago/Turabian StyleChae, Kyunghee, Mira Kim, Byung Ok Kim, Chai Young Jung, Hyun-Jae Kang, Dong-Jin Oh, Dong Woon Jeon, Woo-Young Chung, Cheol Ung Choi, Kyoo-Rok Han, and et al. 2022. "Public Reporting on the Quality of Care in Patients with Acute Myocardial Infarction: The Korean Experience" International Journal of Environmental Research and Public Health 19, no. 6: 3169. https://doi.org/10.3390/ijerph19063169