Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care
Background High patient volumes are associated with better stroke management and outcomes. However, in sparsely populated regions, patients with stroke frequently rely on low‐volume hospitals for acute care. This study evaluates the performance of high‐performing hospitals among low‐volume hospitals...
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| Language: | English |
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Wiley
2025-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038348 |
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| author | Han‐Yeong Jeong Seong‐Eun Kim Kyungbok Lee Jong‐Moo Park Hong‐Kyun Park Yong‐Jin Cho Jun Yup Kim Beom Joon Kim Tae Jung Kim Soo Joo Lee Jonguk Kim Tai Hwan Park Ji Sung Lee Juneyoung Lee Yong Uk Kwon In Ok Bae Gui Ok Kim Philip B. Gorelick Hee‐Joon Bae |
| author_facet | Han‐Yeong Jeong Seong‐Eun Kim Kyungbok Lee Jong‐Moo Park Hong‐Kyun Park Yong‐Jin Cho Jun Yup Kim Beom Joon Kim Tae Jung Kim Soo Joo Lee Jonguk Kim Tai Hwan Park Ji Sung Lee Juneyoung Lee Yong Uk Kwon In Ok Bae Gui Ok Kim Philip B. Gorelick Hee‐Joon Bae |
| author_sort | Han‐Yeong Jeong |
| collection | DOAJ |
| description | Background High patient volumes are associated with better stroke management and outcomes. However, in sparsely populated regions, patients with stroke frequently rely on low‐volume hospitals for acute care. This study evaluates the performance of high‐performing hospitals among low‐volume hospitals and identifies factors contributing to their high performance despite treating fewer stroke cases. Methods and Results We analyzed data from the eighth Acute Stroke Quality Assessment Program in 2018, alongside reimbursement claims and death certificate records, to evaluate stroke care in 248 hospitals across South Korea, including all general and tertiary hospitals. The hospitals treating <100 patients with stroke annually were classified as low‐volume. High performance among these hospitals was defined as achieving a defect‐free care rate of >75%. The outcome measured was the poststroke 1‐year mortality rate. Of 28 572 patients, 2521 (8.8%) were treated in low‐volume hospitals, primarily general hospitals outside the capital area. The 1‐year mortality rate was significantly higher in low‐volume hospitals (24.8%) compared with their high‐volume counterparts (17.6%, adjusted P<0.01). High‐performing low‐volume hospitals exhibited a significantly lower 1‐year mortality rate (21.1%) than low‐performing hospitals (26.9%, adjusted P=0.036), with no significant difference in the number of hospital beds or annual stroke admissions. High‐performing low‐volume hospitals were characterized by their location (P=0.048) and a significantly greater number of physicians, particularly neurologists (P=0.010). The presence of neurologists was also associated with a higher defect‐free care rate in these hospitals. Conclusions This study highlights the status of low‐volume hospitals in providing stroke care in areas with limited access to larger medical facilities. It suggests that enhancing acute stroke care performance, particularly through human resource investments, can significantly improve quality and patient outcomes at these hospitals. |
| format | Article |
| id | doaj-art-708c1fdefb0e4fdd96d6d268296c00be |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-708c1fdefb0e4fdd96d6d268296c00be2025-08-20T02:33:19ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-04-0114810.1161/JAHA.124.038348Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke CareHan‐Yeong Jeong0Seong‐Eun Kim1Kyungbok Lee2Jong‐Moo Park3Hong‐Kyun Park4Yong‐Jin Cho5Jun Yup Kim6Beom Joon Kim7Tae Jung Kim8Soo Joo Lee9Jonguk Kim10Tai Hwan Park11Ji Sung Lee12Juneyoung Lee13Yong Uk Kwon14In Ok Bae15Gui Ok Kim16Philip B. Gorelick17Hee‐Joon Bae18Department of Neurology Emergency Medical Center, Seoul National University Hospital, Seoul National University College of Medicine Seoul Republic of KoreaDepartment of Neurology and Cerebrovascular Center Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam Republic of KoreaDepartment of Neurology Soonchunhyang University Hospital, Soonchunhyang University College of Medicine Seoul Republic of KoreaDepartment of Neurology Uijeongbu Eulji Medical Center, Eulji University Uijeongbu Republic of KoreaDepartment of Neurology Inje University Ilsan Paik Hospital Goyang Republic of KoreaDepartment of Neurology Inje University Ilsan Paik Hospital Goyang Republic of KoreaDepartment of Neurology and Cerebrovascular Center Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam Republic of KoreaDepartment of Neurology and Cerebrovascular Center Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam Republic of KoreaDepartment of Neurology and Critical Care Medicine Seoul National University Hospital Seoul Republic of KoreaDepartment of Neurology Eulji University Hospital Daejeon Republic of KoreaDepartment of Neurology Inha University Hospital Incheon Republic of KoreaDepartment of Neurology Seoul Medical Center Seoul Republic of KoreaClinical Research Center Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine Seoul Republic of KoreaDepartment of Biostatistics Korea University College of Medicine Seoul Republic of KoreaHealthcare Review and Assessment Committee Health Insurance Review and Assessment Service Wonju Republic of KoreaQuality Assessment Department Health Insurance Review and Assessment Service Wonju Republic of KoreaQuality Assessment Department Health Insurance Review and Assessment Service Wonju Republic of KoreaDavee Department of Neurology, Division of Stroke and Neurocritical Care Northwestern University Feinberg School of Medicine Chicago Illinois USADepartment of Neurology and Cerebrovascular Center Seoul National University Bundang Hospital, Seoul National University College of Medicine Seongnam Republic of KoreaBackground High patient volumes are associated with better stroke management and outcomes. However, in sparsely populated regions, patients with stroke frequently rely on low‐volume hospitals for acute care. This study evaluates the performance of high‐performing hospitals among low‐volume hospitals and identifies factors contributing to their high performance despite treating fewer stroke cases. Methods and Results We analyzed data from the eighth Acute Stroke Quality Assessment Program in 2018, alongside reimbursement claims and death certificate records, to evaluate stroke care in 248 hospitals across South Korea, including all general and tertiary hospitals. The hospitals treating <100 patients with stroke annually were classified as low‐volume. High performance among these hospitals was defined as achieving a defect‐free care rate of >75%. The outcome measured was the poststroke 1‐year mortality rate. Of 28 572 patients, 2521 (8.8%) were treated in low‐volume hospitals, primarily general hospitals outside the capital area. The 1‐year mortality rate was significantly higher in low‐volume hospitals (24.8%) compared with their high‐volume counterparts (17.6%, adjusted P<0.01). High‐performing low‐volume hospitals exhibited a significantly lower 1‐year mortality rate (21.1%) than low‐performing hospitals (26.9%, adjusted P=0.036), with no significant difference in the number of hospital beds or annual stroke admissions. High‐performing low‐volume hospitals were characterized by their location (P=0.048) and a significantly greater number of physicians, particularly neurologists (P=0.010). The presence of neurologists was also associated with a higher defect‐free care rate in these hospitals. Conclusions This study highlights the status of low‐volume hospitals in providing stroke care in areas with limited access to larger medical facilities. It suggests that enhancing acute stroke care performance, particularly through human resource investments, can significantly improve quality and patient outcomes at these hospitals.https://www.ahajournals.org/doi/10.1161/JAHA.124.038348human resourceslow‐volume hospitalneurologiststrokestroke care |
| spellingShingle | Han‐Yeong Jeong Seong‐Eun Kim Kyungbok Lee Jong‐Moo Park Hong‐Kyun Park Yong‐Jin Cho Jun Yup Kim Beom Joon Kim Tae Jung Kim Soo Joo Lee Jonguk Kim Tai Hwan Park Ji Sung Lee Juneyoung Lee Yong Uk Kwon In Ok Bae Gui Ok Kim Philip B. Gorelick Hee‐Joon Bae Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease human resources low‐volume hospital neurologist stroke stroke care |
| title | Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care |
| title_full | Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care |
| title_fullStr | Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care |
| title_full_unstemmed | Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care |
| title_short | Characteristics of High‐Performance Low‐Volume Hospitals in Acute Stroke Care |
| title_sort | characteristics of high performance low volume hospitals in acute stroke care |
| topic | human resources low‐volume hospital neurologist stroke stroke care |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038348 |
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