title: Establishment of government-initiated comprehensive stroke centers for acute ischemic stroke management in South Korea.
abstract: OBJECTIVE
  In 2008, the Ministry of Health and Welfare of South Korea initiated the Regional Comprehensive Stroke Center (CSC) program to decrease the incidence and mortality of stroke nationwide. We evaluated the performance of acute ischemic stroke management after the Regional CSC program was introduced.
  
  
  METHODS
  The Ministry of Health and Welfare established 9 Regional CSCs in different provinces from 2008 to 2010. All Regional CSCs have been able to execute the critical processes independently for stroke management since 2011. The Ministry of Health and Welfare was responsible for program development and financial support, the Regional CSC for program execution, and the Korea Centers for Disease Control and Prevention for auditing the execution. We analyzed prospectively collected data on the required indices from 2011 and repeated the analysis the following year for comparison.
  
  
  RESULTS
  After the Regional CSCs were established, the first brain image was taken within 1 hour from arrival at the emergency room for all patients with stroke; the length of hospital stay decreased from 14 to 12 days; for the rapid execution of thrombolysis, the first brain image was taken within 12 minutes; intravenous and intra-arterial thrombolysis were started within 40 and 110 minutes, respectively, after emergency room arrival; and the hospital stay of thrombolytic patients decreased from 19 to 15 days.
  
  
  CONCLUSIONS
  The Regional CSC program has improved the performance of acute stroke management in South Korea and can be used as a model for rapidly improving stroke management.
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.). jeikim@cnu.ac.kr.
authors.forename: Jei
authors.initials: J
authors.lastname: Kim
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Yang-Ha
authors.initials: YH
authors.lastname: Hwang
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Nack-Cheon
authors.initials: NC
authors.lastname: Choi
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Sa-Yoon
authors.initials: SY
authors.lastname: Kang
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Ha
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Dong-Ick
authors.initials: DI
authors.lastname: Shin
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Seongheon
authors.initials: S
authors.lastname: Kim
authors.affiliation: From the Daejeon-Chungnam Regional Cerebrovascular Center, Daejeon, South Korea (J.K.); Daegu-Gyeongbuk Regional Cerebrovascular Center, Daegu, South Korea (Y.-H.H.); Gwangju-Jeonnam Regional Cerebrovascular Center, Gwangju, South Korea (J.-T.K.); Gyeongnam Regional Cerebrovascular Center, Jinju, South Korea (N.-C.C., B.-H.L.); Jeju Regional Cerebrovascular Center, Jeju, South Korea (S.-Y.K.); Busan-Ulsan Regional Cerebrovascular Center, Busan, South Korea (J.-K.C.); Jeonbuk Regional Cerebrovascular Center, Iksan, South Korea (Y.S.H.); Chungbuk Regional Cerebrovascular Center, Cheongju, South Korea (D.-I.S.); and Gangwon Regional Cerebrovascular Center, Chuncheon, South Korea (S.K.).
authors.forename: Byeong-Hoon
authors.initials: BH
authors.lastname: Lim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006076:Government; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009026:Mortality; D056910:Republic of Korea; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: South Korea; comprehensive stroke care; thrombolytic therapy