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QUALITY AND OUTCOME OF ACUTE CARDIO-CEREBROVASCULAR DISEASE CARE AT THE GOVERNMENT-INITIATED REGIONAL CARDIO-CEREBROVASCULAR DISEASE CENTER
Abstract
Background and Aims
In 2008, the Ministry of Health and Welfare of South Korea launched the Regional Cardio-cerebrovascular Disease Center (RCCVC) program to reduce the regional disparity of stroke incidence and mortality nationwide. From 2008 to 2018, 14 RCCVCs were installed and the established RCCVCs operated independently for stroke management in each region.
Methods
We evaluated the outcomes of acute stroke management after the RCCVC program was introduced. We analyzed in combination with the data of Korea Disease Control and Prevention Agency's Acute Stroke Quality Assessment Program and the data of the Health Insurance Review and Assessment Service evaluated in 299 acute stroke care hospitals in 6 rounds from 2010 to 2018. The hospitals were analyzed by dividing them into RCCVC, non-RCCVC, comprehensive stroke centers (CSC) in Seoul, and non-CSC in Seoul. The outcome measures were defect-free stroke care and mortality rate.
Results
Among 94,976 acute stroke cases (mean age, 67±14 years, male, 55%), 69,997 (73.7%) were ischemic strokes. Defect-free care increased from 50.2% in 2010 to 86.0% in 2018 in RCCVCs, which significantly reduced the gap with CSC in Seoul (62.1% in 2010, 88.0% in 2018). The 1-year mortality rate decreased from 16.4% in 2010 to 14.4% in 2018 in RCCVCs, similar to that in CSC in Seoul (16.9% in 2010, 13.1% in 2018). The 1-year mortality rate of the RCCVCs was significantly reduced compared to that of the non-RCCVC. (OR 0.88, 95% CI 0.78-0.99, p=0.037).
Conclusions
The RCCVC program has improved acute stroke management and outcomes and contributed to reducing regional disparity.