Impact of implementing the hierarchical system of emergent rescuer responsive hospitals on processes and outcomes of care for patients with acute ischemic stroke
Date Issued
2014
Date
2014
Author(s)
Wu, Chen-I
Abstract
Backgrounds: Cerebrovascular disease is the third leading cause of death in Taiwan. To improve processes and outcomes of care in acute ischemic stroke patients, many countries have developed the acute stroke system toward the regionalization by establishing the stroke centers and implementing the stroke center designation project. The hierarchical system of emergent rescuer responsive hospitals which combines the concept of stroke center with responsive hospitals was implemented in Taiwan in July 2009. Recently, there is little research to analyze the effectiveness of the stroke center designation project in the processes and outcomes of care.
Objectives: The main purpose of this study is to evaluate the association of the implementation of the hierarchical system of emergent rescuer responsive hospitals with processes and outcomes of care for patients with acute ischemic stroke.
Methods: A retrospective population-based study used claims data of 1 million sampled registry from Taiwan National Health Insurance Research Database. The study population were all patients admitted with acute ischemic stroke to each hospital from 2006 to 2011. Generalized Estimating Equations (GEE) were used to test the hypotheses, adjusting for the characteristics of patients and hospitals.
Results: After implementing the hierarchical system of emergent rescuer responsive hospitals, the utilization of the recombinant tissue plasminogen activator (rt-PA) has increased and reached marginally significant. The utilization of CT/MRI has significantly increased after the implementation.
Conclusions: Due to the implementation of the hierarchical system of emergent rescuer responsive hospitals, there are improvements in certain processes of care, but there is no improvement in outcomes of care for patients with acute ischemic stroke.
Subjects
腦中風
醫院緊急醫療能力分級
Type
thesis
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