RT Journal Article
SR Electronic
T1 Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e033055
DO 10.1136/bmjopen-2019-033055
VO 10
IS 8
A1 Ai Kurogi
A1 Ataru Nishimura
A1 Kunihiro Nishimura
A1 Akiko Kada
A1 Daisuke Onozuka
A1 Akihito Hagihara
A1 Kuniaki Ogasawara
A1 Yoshiaki Shiokawa
A1 Takanari Kitazono
A1 Koichi Arimura
A1 Koji Iihara
A1 ,
YR 2020
UL http://bmjopen.bmj.com/content/10/8/e033055.abstract
AB Objectives Comprehensive stroke centre (CSC) capabilities are associated with reduced in-hospital mortality due to acute stroke. However, it remains unclear whether there are improving trends in the CSC capabilities or how hospital-related factors determine quality improvement. This study examined whether CSC capabilities changed in Japan between 2010 and 2018 and and whether any changes were influenced by hospital characteristics.Design A hospital-based cross-sectional study.Setting We sent out questionnaires to the training institutions of the Japan Neurosurgical Society and Japan Stroke Society in 2010, 2014 and 2018.Participants 749 hospitals in 2010, 532 hospitals in 2014 and 786 hospitals in 2018 participated in the J-ASPECT study, a nationwide survey of acute stroke care capacity for proper designation of a comprehensive stroke centre in Japan.Main outcome measures CSC capabilities were assessed using the validated scoring system (CSC score: 1–25 points) in 2010, 2014 and 2018 survey. The effect of hospital characteristics was examined using multiple logistic regression analysis.Results Among the 323 hospitals that responded to all surveys, the implementation of 13 recommended items increased. The CSC score (median and IQR) was 16 (13–19), 18 (14–20) and 19 (15–21) for 2010, 2014 and 2018, respectively (p<0.001). There was a ≥20% increase in six items (eg, endovascular physicians, stroke unit and interventional coverage 24/7), and a ≤20% decrease in community education. A lower baseline CSC score (OR: 0.82, 95% CI 0.75 to 0.9), the number of beds≥500 (OR: 3.9, 95% CI 1.2 to 13.0) and the number of stroke physicians (7–9) (OR: 2.6, 95% CI 1.1 to 6.3) were associated with improved CSC capabilities, independent of geographical location.Conclusions There was a significant improvement in CSC capabilities between 2010 and 2018, which was mainly related to the availability of endovascular treatment and multidisciplinary care. Our findings may be useful to determine which hospitals should be targeted to improve CSC capabilities in a defined area.