title: Effective strategy for improving health care outcomes: Multidisciplinary care in cerebral infarction patients.
abstract: Multidisciplinary teams provide effective patient treatment strategies. South Korea expanded its health program recently to include multidisciplinary treatment. This study characterized the relationship between multidisciplinary care and mortality within 30 days after hospitalization in cerebral infarction patients. We used the National Health Insurance claim data (n = 63,895) from 120 hospitals during 2010-2013 to analyze readmission within 30 days after hospitalization for cerebral infarction. We performed χ(2) tests, analysis of variance and multilevel modeling to investigate the associations between multidisciplinary care and death within 30 days after hospitalization for stroke. Deaths within 30 days of hospitalization due to cerebral infarction was 3.0% (n = 1898/63,895). Multidisciplinary care was associated with lower risk of death within 30 days in inpatients with cerebral infarction (odds ratio: 0.84, 95% confidence interval: 0.72-0.99). Patients treated by a greater number of specialists had lower risk of death within 30 days of hospitalization. Additional analyses showed that such associations varied by the combination of specialists (i.e., neurologist and neurosurgeon). In conclusion, death rates within 30 days of hospitalization for cerebral infarction were lower in hospitals with multidisciplinary care. Our findings certainly suggest that a high number of both neurosurgeon and neurologist is not always an effective alternative in managing stroke inpatients, and emphasize the importance of an optimal combination in the same number of hospital staffing.
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: 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: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: 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.
authors.forename: Woorim
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Health Administration and Management, Soonchunhyang University, Asan, Republic of Korea.
authors.forename: Myung-Il
authors.initials: MI
authors.lastname: Hahm
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: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea. Electronic address: LEEVAN@yuhs.ac.
authors.forename: Sang Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000401:mortality / Q000628:therapy*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D056910:Republic of Korea; D016896:Treatment Outcome
keywords: 30-day mortality; Collaborative care; Multidisciplinary care; Stroke