https://scholars.lib.ntu.edu.tw/handle/123456789/493682
Title: | The Relationships among Regionalization, Processes, and Outcomes for Stroke Care | Authors: | YU-CHI TUNG Chang G.-M. |
Issue Date: | 2016 | Publisher: | Lippincott Williams and Wilkins | Journal Volume: | 95 | Journal Issue: | 15 | Start page/Pages: | e3327 | Source: | Medicine (United States) | Abstract: | Regionalization for stroke care, including stroke center designation, is being implemented in the United States, Canada, or other countries. Limited information is available, however, concerning the relationships among regionalization, processes, and outcomes for stroke care. We examined the association of regionalization with processes and outcomes, and the mediating effect of processes of care on the association between regionalization and mortality for acute stroke in Taiwan. We analyzed all 229,568 admissions with acute ischemic stroke from January 2004 to September 2012 through Taiwan's National Health Insurance Research Database. Regionalized care for acute stroke has been implemented since July 2009 in Taiwan. Rates of thrombolytic therapy within 3hours after onset of ischemic stroke, average numbers of processes of care, and 30-day mortality rates at monthly intervals for baseline (66 months) and 39 months after the implementation of regionalization. After accounting for secular trends and other confounders, changes in rates of thrombolytic therapy (level change 0.269% per month, P=0.017 and trend change 0.010% per month, P=0.048), average numbers of processes of care (trend change 0.001 per month, P=0.030), and 30-day mortality rates (level change-0.442% per month, P=0.007 and trend change-0.021% per month, P=0.015) were attributable to regionalization. The processes of care were mediators of the association between regionalization and 30-day mortality after stroke. Regionalization for stroke care may improve timeliness and processes of stroke care, including access to timely thrombolytic therapy from emergency medical services to hospital care, which may in turn enhance stroke outcomes. ? 2016 Wolters Kluwer Health, Inc. All rights reserved. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84971654763&doi=10.1097%2fMD.0000000000003327&partnerID=40&md5=c6d30c9ce88363c3a159855158eafa16 https://scholars.lib.ntu.edu.tw/handle/123456789/493682 |
ISSN: | 0025-7974 | DOI: | 10.1097/MD.0000000000003327 | SDG/Keyword: | aged; Article; brain ischemia; emergency health service; female; fibrinolytic therapy; hospital admission; hospital care; human; major clinical study; male; mortality rate; outcome assessment; patient care; priority journal; regionalization; Taiwan; fibrinolytic therapy; health care planning; organization and management; procedures; statistics and numerical data; Stroke; time to treatment; total quality management; treatment outcome; Aged; Female; Humans; Male; Outcome and Process Assessment (Health Care); Patient Care Management; Quality Improvement; Regional Medical Programs; Stroke; Taiwan; Thrombolytic Therapy; Time-to-Treatment |
Appears in Collections: | 健康政策與管理研究所 |
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