Institutional Variance in Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction in
Hayato Yamana1,2, Seyune Lee3, Yi-Chieh Lin4
1Data Science Center, Jichi Medical University, Shimotsuke, Japan.
Insights
This study compared hospital variations in mortality after percutaneous coronary intervention for acute myocardial infarction across Korea, Japan, and Taiwan. While outcomes were generally uniform, Japan showed higher institutional mortality variance not fully explained by hospital factors.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Comparative Effectiveness
Background:
- Studies often compare acute myocardial infarction (AMI) outcomes internationally, but institutional variations within countries are less explored.
- Understanding hospital-level differences in outcomes is crucial for improving care quality.
- This research addresses the gap by examining institutional variance in mortality after percutaneous coronary intervention (PCI) for AMI.
Purpose of the Study:
- To compare institutional variance in inpatient mortality following PCI for AMI across three distinct health systems: Korea, Japan, and Taiwan.
- To identify factors contributing to or explaining the observed institutional variance in mortality rates.
Main Methods:
- Utilized nationwide inpatient data from Korea, Japan, and Taiwan for patients undergoing PCI for AMI in 2016.
- Employed multilevel analyses to assess inpatient mortality, accounting for patient and hospital-level variables.
- Compared intraclass correlation coefficients (ICC) and the proportion of variance explained by hospital characteristics.
Main Results:
- Inpatient mortality rates were 6.3% (Korea), 7.3% (Japan), and 6.0% (Taiwan).
- After adjustments, Taiwan exhibited the lowest mortality variation (ICC 1.8%), followed by Korea (2.2%) and Japan (4.5%).
- Hospital characteristics explained 38% of variance in Korea, 19% in Taiwan, and 9% in Japan.
Conclusions:
- Outcomes for patients undergoing PCI for AMI were broadly uniform across hospitals in Korea, Japan, and Taiwan.
- Japan demonstrated a larger institutional variance in mortality compared to Korea and Taiwan.
- A lower proportion of this variance in Japan was explained by measured hospital characteristics, suggesting other factors may be at play.
Background:
Although there have been studies that compared outcomes of patients with acute myocardial infarction (AMI) across countries, little focus has been placed on institutional variance of outcomes. The aim of the present study was to compare institutional variance in mortality following percutaneous coronary intervention (PCI) for AMI and factors explaining this variance across different health systems.
Methods:
Data on inpatients who underwent PCI for AMI in 2016 were obtained from the National Health Insurance Data Sharing Service in Korea, the Diagnosis Procedure Combination (DPC) Study Group Database in Japan, and the National Health Insurance Research Database (NHIRD) in Taiwan. Multilevel analyses with inpatient mortality as the outcome and the hierarchical structure of patients nested within hospitals were conducted, adjusting for common patient-level and hospital-level variables. We compared the intraclass correlation coefficient (ICC) and the proportion of variance explained by hospital-level characteristics across the three health systems.
Results:
There were 17 351 patients from 160 Korean hospitals, 29 804 patients from 660 Japanese hospitals, and 10 863 patients from 104 Taiwanese hospitals included in the analysis. Inpatient mortality rates were 6.3%, 7.3%, and 6.0% in Korea, Japan, and Taiwan, respectively. After adjusting for patient and hospital characteristics, Taiwan had the lowest variation in mortality (ICC, 1.8%), followed by Korea (2.2%) and then Japan (4.5%). The measured hospital characteristics explained 38%, 19%, and 9% of the institutional variance in Korea, Taiwan, and Japan, respectively.
Conclusion:
Korea, Japan, and Taiwan had similarly uniform outcomes across hospitals for patients undergoing PCI for AMI. However, Japan had a relatively large institutional variance in mortality and a lower proportion of variation explainable by hospital characteristics, compared with Korea and Taiwan.
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