title: Positive correlation between care given by specialists and registered nurses and improved outcomes for stroke patients.
abstract: BACKGROUND
  Cerebrovascular diseases are the second-highest cause of death in South Korea (9.6% of all causes of mortality in 2013). South Korea has a shortage of trained medical personnel compared with other countries and the demands for health care are continuously increasing. Our study sought to determine the relationship between hospital human resources and the outcomes of stroke patients.
  
  
  METHODS
  We used data from NHI claims (n=99,464) at 120 hospitals to analyze readmission or death within 30 days after discharge or hospitalization for stroke patients during 2010-2013. We used multilevel models that included both patient-level and hospital-level variables to examine factors associated with readmission or death within 30 days.
  
  
  RESULTS
  A total of 1782 (1.8%) patients were readmitted within 30 days, and death occurred within 30 days for 6926 (7.0%) patients. Patients cared for by a higher percentages of specialists or registered nurses had a lower risk of readmission or death within 30 days (readmission per 10% increase in registered nurses, OR=0.89 and SD=0.85-0.94; death per 10% increase in specialists, OR=0.93 and SD=0.89-0.98).
  
  
  CONCLUSIONS
  The percentages of specialist and registered nurses caring for stroke patients were positively correlated with better patient outcomes, particularly for patients with cerebral infarction.
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyu-Tae
authors.initials: KT
authors.lastname: Han
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Department of Health Administration, Namseoul University, Cheonan, Republic of Korea.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung-In
authors.initials: SI
authors.lastname: Jang
authors.affiliation: Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Ju
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: Seo Yoon
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ecpark@yuhs.ac.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D017028:Caregivers; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D056910:Republic of Korea; D013038:Specialization; D013223:Statistics as Topic; D020521:Stroke / Q000451:nursing*; D016896:Treatment Outcome
keywords: Death; Quality of care; Readmission; Registered nurse; Specialist; Stroke