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KMID : 0359720230410010018
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Journal of the Korean Neurological Association
2023 Volume.41 No. 1 p.18 ~ p.30
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Quality of Acute Stroke Care within Emergency Medical Service System in Korea: Proposal for Severe Emergency Medical Center
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Lee Kyung-Bok
Lee Ji-Sung
Lee Jeong-Yoon
Kim Jun-Yup
Jeong Han-Young
Kim Seong-Eun
Kim Jong-Uk
Kim Do-Yeon
Lee Keon-Joo
Kang Ji-Hoon
Kim Beom-Joon
Kim Tae-Jung
Ahn Sang-Jun
Baek Jang-Hyun
Kim Seong-Heon
Nah Hyun-Wook
Lee Jong-Yun
Kwon Jee-Hyun
Ahn Seong-Hwan
Jung Keun-Hwa
Park Hee-Kwon
Park Jong-Moo
Cho Young-Jin
Koh Im-Seok
Lee Soo-Joo
Cha Jae-Kwan
Rha Joung-Ho
Lee June-Young
Lee Boung-Chul
Bae In-Ok
Kim Gui-Ok
Bae Hee-Joon
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Abstract
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ackground: 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.
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KEYWORD
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Emergency medical services, Acute stroke, First aid, Quality of health care, Mortality
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