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Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018
OBJECTIVES: Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412582/ https://www.ncbi.nlm.nih.gov/pubmed/32764079 http://dx.doi.org/10.1136/bmjopen-2019-033055 |
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author | Kurogi, Ai Nishimura, Ataru Nishimura, Kunihiro Kada, Akiko Onozuka, Daisuke Hagihara, Akihito Ogasawara, Kuniaki Shiokawa, Yoshiaki Kitazono, Takanari Arimura, Koichi Iihara, Koji |
author_facet | Kurogi, Ai Nishimura, Ataru Nishimura, Kunihiro Kada, Akiko Onozuka, Daisuke Hagihara, Akihito Ogasawara, Kuniaki Shiokawa, Yoshiaki Kitazono, Takanari Arimura, Koichi Iihara, Koji |
author_sort | Kurogi, Ai |
collection | PubMed |
description | OBJECTIVES: Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics. DESIGN: A hospital-based cross-sectional study. SETTING: We sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018. PARTICIPANTS: 749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan. MAIN OUTCOME MEASURES: CSC capabilities were assessed using the validated scoring system (CSC score: 1–25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis. RESULTS: Among the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13–19), 18 (14–20) and 19 (15–21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20% increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20% decrease in community education. A lower baseline CSC score (OR: 0.82, 95% CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95% CI 1.2 to 13.0) and the number of stroke physicians (7–9) (OR: 2.6, 95% CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location. CONCLUSIONS: There was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area. |
format | Online Article Text |
id | pubmed-7412582 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-74125822020-08-17 Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 Kurogi, Ai Nishimura, Ataru Nishimura, Kunihiro Kada, Akiko Onozuka, Daisuke Hagihara, Akihito Ogasawara, Kuniaki Shiokawa, Yoshiaki Kitazono, Takanari Arimura, Koichi Iihara, Koji BMJ Open Neurology OBJECTIVES: Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics. DESIGN: A hospital-based cross-sectional study. SETTING: We sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018. PARTICIPANTS: 749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan. MAIN OUTCOME MEASURES: CSC capabilities were assessed using the validated scoring system (CSC score: 1–25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis. RESULTS: Among the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13–19), 18 (14–20) and 19 (15–21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20% increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20% decrease in community education. A lower baseline CSC score (OR: 0.82, 95% CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95% CI 1.2 to 13.0) and the number of stroke physicians (7–9) (OR: 2.6, 95% CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location. CONCLUSIONS: There was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area. BMJ Publishing Group 2020-08-06 /pmc/articles/PMC7412582/ /pubmed/32764079 http://dx.doi.org/10.1136/bmjopen-2019-033055 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Neurology Kurogi, Ai Nishimura, Ataru Nishimura, Kunihiro Kada, Akiko Onozuka, Daisuke Hagihara, Akihito Ogasawara, Kuniaki Shiokawa, Yoshiaki Kitazono, Takanari Arimura, Koichi Iihara, Koji Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title | Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title_full | Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title_fullStr | Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title_full_unstemmed | Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title_short | Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018 |
title_sort | temporal trends and geographical disparities in comprehensive stroke centre capabilities in japan from 2010 to 2018 |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412582/ https://www.ncbi.nlm.nih.gov/pubmed/32764079 http://dx.doi.org/10.1136/bmjopen-2019-033055 |
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