우리나라 응급의료 중진료권별 급성 뇌졸중 진료수준: 중증응급의료센터를 위한 제언
Quality of Acute Stroke Care within Emergency Medical Service System in Korea: Proposal for Severe Emergency Medical Center
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Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions: There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.
Abstract
Background: Korea recently established 70 emergency medical service areas. However, there are many concerns that medical resources for stroke could not be evenly distributed through the country. We aimed to compare the treatment quality and outcomes of acute stroke among the emergency medical service areas. Methods: This study analyzed the data of 28,800 patients admitted in 248 hospitals which participated in the 8th acute stroke quality assessment by Health Insurance Review and Assessment Service. Individual hospitals were regrouped into emergency service areas according to the address of the location. Assessment indicators and fatality were compared by the service areas. We defined the appropriate hospital by the performance of intravenous thrombolysis. Results: In seven service areas, there were no hospitals which received more than 10 stroke patients for 6 months. In nine service areas, there were no patients who underwent intravenous thrombolysis (IVT). Among 167 designated emergency medical centers, 50 hospitals (29.9%) responded that IVT was impossible 24 hours a day. There are 97 (39.1%) hospitals that meet the definitions of appropriate hospital. In 23 service areas (32.9%) had no appropriate or feasible hospitals. The fatality of service areas with stroke centers were 6.9% within 30 days and 15.6% within 1 year from stroke onset than those without stroke centers (7.7%, 16.9%, respectively). Conclusions: There was a wide regional gap in the medical resource and the quality of treatments for acute stroke among emergency medical service areas in Korea. The poststroke fatality rate of the service areas which have stroke centers or appropriate hospitals were significantly low.
참고문헌 (16)
- 임지혜, "뇌졸중 환자의 사망 추적연구", 대한의사협회지, 54(11), pp.1199~1208 (2011), 대한의사협회
- Alberts MJ, "Recommendations for the establishment of primary stroke centers. Brain attack coalition", JAMA, 283, pp.3102~3109 (2000)
- Adams R, "Recommendations for improving the quality of care through stroke centers and systems : an examination of stroke center identification options : multidisciplinary consensus recommendations from the Advisory Working Group on Stroke Center Identification Options of the American Stroke Association", Stroke, 33, pp.e1~e7 (2002)
- Ebinger M, "Shifting acute stroke management to the prehospital setting", Curr Opin Neurol, 35, pp.4~9 (2022)
- 건강보험 의료이용지도(KNHI-Atlas) 구축 3차 연구 최종보고서, "Seoul National University R&DB Foundation", National Health Insurance Service, ~, pp.연구용역보고서-2017-2-0028 (2018)
- "환자 발생 지역에서 최적의 진료를 제공하는 ‘지역 완결형 응급의료체계’ 실행방안 마련" (2021)[URL]
- "공공의료 강화 위해 설정된 70개 중진료권… 醫, ‘개선’목소리 높여" (2021)[URL]
- Fonarow GC, "Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative", JAMA, 311, pp.1632~1640 (2014)
- "Thrombectomy-Capable Stroke Center Certification"[URL]
- 김범준, "Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea", 대한뇌졸중영문학회지, 17(1), pp.38~53 (2015), 대한뇌졸중학회
- Kleindorfer D, "National US estimates of recombinant tissue plasminogen activator use : ICD-9 codes substantially underestimate", Stroke, 39, pp.924~928 (2008)
- Adeoye O, "Recombinant tissuetype plasminogen activator use for ischemic stroke in the United States : a doubling of treatment rates over the course of 5 years", Stroke, 42, pp.1952~1955 (2011)
- 이남진, "급성 뇌졸중 의심 환자의 병원 전 지연 원인 분석", 한국응급구조학회지, 24(2), pp.27~38 (2020), 사단법인 한국응급구조학회[DOI]
- "뇌졸중환자 5명 중 1명은 첫 병원서 치료 못받아… “뇌졸중센터 지역불균형이 문제”" (2022)[URL]
- "광역시별 승용차 및 시내버스 평균 통행속도" (1995)[URL]