The burden of acute myocardial infarction after a regional cardiovascular center project in Korea.
OBJECTIVE
The aim of this study was to examine the impact of a government-directed regional cardiovascular center (RCVC) project on the length of stay (LOS) and medical costs due to acute myocardial infarction (AMI).


METHODS
A retrospective claim data review.


METHODS
Forty hospitals including four RCVCs in Korea.


METHODS
A total of 1469 AMI patients who visited a RCVC in two regions between February 2009 and December 2011.


METHODS
RCVC project has been fostering specialized center by region for management of cardiovascular disease. It has built a system that could receive intensive care quickly within 3 h when disease occurred.


METHODS
Changes in the LOS and cost were evaluated using the difference-in-differences (DIDs) method combined with propensity score matching (1:1) and multilevel analysis with adjustment for patient's and institutional factors.


RESULTS
The net effect of RCVC project implementation showed decline of LOS (-0.71 days) and total medical costs (-797 US dollars) by DID. After the RCVC project, the LOS for patients with AMI hospitalized in a RCVC was decreased by 8.9% (β = -0.094, P = 0.041) compared with patients hospitalized in a hospital not designed as a RCVC. Compared with costs before the RCVC project, they were decreased by 11.5% (β = -0.122, P = 0.004).


CONCLUSIONS
We provided evidence regarding the change in the societal burden due to AMI after regionalization. Although there was a reduction of LOS and direct medical costs reported in limited number of regionalized hospitals, in the long term we can anticipate an expanding impact in all regionalized hospitals.
Graduate School of Public Health, Korea University of Seoul, Seoul 136-705, South Korea.
Arim
A
Kim
Department of Preventive Medicine, College of Medicine, Korea University, Seoul 136-705, South Korea.
Seok-Jun
SJ
Yoon
Cancer Policy Branch, National Cancer Center, Goyang 410-769, South Korea.
Young-Ae
YA
Kim
Economic Research Institute, Korea University of Seoul, Seoul 136-701, South Korea.
Eun Jung
EJ
Kim
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D056910:Republic of Korea; D012189:Retrospective Studies; D012737:Sex Factors
cardiovascular diseases; care pathways/disease management; evaluation methodology; health policy; health services research