title: Associations of volume and other hospital characteristics on mortality within 30 days of acute myocardial infarction in South Korea.
abstract: OBJECTIVE
  The mortality for acute myocardial infarction (AMI) has declined worldwide. However, improvements in care for AMI in South Korea have lagged slightly behind those in other countries. Therefore, it is important to investigate how factors such as hospital volume, structural characteristics of hospital and hospital staffing level affect 30-day mortality due to AMI in South Korea.
  
  
  METHODS
  We used health insurance claim data from 114 hospitals to analyse 30-day mortality for AMI.
  
  
  METHODS
  These data consisted of 19,638 hospitalisations during 2010-2013.
  
  
  METHODS
  No interventions were made.
  
  
  METHODS
  Multilevel models were analysed to examine the association between the 30-day mortality and inpatient and hospital level variables.
  
  
  RESULTS
  In the 30 days after hospitalisation, 10.5% of patients with AMI died. Hospitalisation cases at hospitals with a higher AMI volume had generally inverse associations with 30-day mortality (1st quartile=ref; 2nd quartile=OR 0.811, 95% CI 0.658 to 0.998, 3rd quartile=OR 0.648, 95% CI 0.500 to 0.840, 4th quartile=OR 0.807, 95% CI 0.573 to 1.138). In addition, hospitals with a greater proportion of specialists were associated with better outcomes (above median=OR 0.789, 95% CI 0.663 to 0.940).
  
  
  CONCLUSIONS
  Health policymakers need to include volume and staffing when defining the framework for treatment of AMI in South Korean hospitals. Otherwise, they must consider increasing the proportion of specialists or regulating the hiring of emergency medicine specialists. In conclusion, they must make an effort to reduce 30-day mortality following AMI based on such considerations.
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 Health Administration and Management, Soonchunhyang University, Asan, 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 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 Hospital Management, Eulji University, Seongnam, Republic of Korea.
authors.forename: Ki-Bong
authors.identifier: http://orcid.org/0000-0001-7073-8586
authors.initials: KB
authors.lastname: Yoo
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, 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 Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000208:Acute Disease; D000368:Aged; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D056910:Republic of Korea / Q000453:epidemiology