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Jun HS, Yang K, Kim J, Jeon JP, Kim SJ, Ahn JH, Lee SJ, Choi HJ, Chang IB, Park JJ, Rhim JK, Jin SC, Cho SM, Joo SP, Sheen SH, Lee SH. Telemedicine Protocols for the Management of Patients with Acute Spontaneous Intracerebral Hemorrhage in Rural and Medically Underserved Areas in Gangwon State : Recommendations for Doctors with Less Expertise at Local Emergency Rooms. J Korean Neurosurg Soc 2024; 67:385-396. [PMID: 37901932 PMCID: PMC11220410 DOI: 10.3340/jkns.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023] Open
Abstract
Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decade. The available reporting ICH guidelines are realistically possible in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.
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Affiliation(s)
- Hyo Sub Jun
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Kuhyun Yang
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Korea
| | - Jongyeon Kim
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Sun Jeong Kim
- Department of Convergence Software, Hallym University, Chuncheon, Korea
| | - Jun Hyong Ahn
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Hyuk Jai Choi
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - In Bok Chang
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Jong-Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sung Min Cho
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Hyung Lee
- Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - on behalf of the Gangwon State Neurosurgery Consortium
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Korea
- Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon, Korea
- Department of Convergence Software, Hallym University, Chuncheon, Korea
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju, Korea
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Korea
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Department of Neurosurgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
- Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Jin DL, Kim KH, Chung ES, Yoon SJ. Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study. J Prev Med Public Health 2024; 57:260-268. [PMID: 38857891 PMCID: PMC11164609 DOI: 10.3961/jpmph.24.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. METHODS A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. RESULTS The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). CONCLUSIONS Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.
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Affiliation(s)
- Dal-Lae Jin
- Department of Public Health, Graduate School of Korea University, Seoul, Korea
- Transdisciplinary Major in Learning Health Systems, Graduate School of Korea University, Seoul, Korea
| | - Kyoung-Hoon Kim
- Department of Health Administration, College of Nursing and Health, Kongju National University, Gongju, Korea
| | - Euy Suk Chung
- Department of Thoracic and Cardiovascular Surgery, Kangbuk Samsung Hospital, Seoul, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Future Public Health, Graduate School of Public Health, Korea University, Seoul, Korea
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Kim SE, Yoo BS. Treatment Strategies of Improving Quality of Care in Patients With Heart Failure. Korean Circ J 2023; 53:294-312. [PMID: 37161744 PMCID: PMC10172273 DOI: 10.4070/kcj.2023.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 04/03/2023] Open
Abstract
Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.
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Im SI. What Regional Disparity Trends of Cardiovascular Mortality Have Changed in 2019 Compared to the 1980s? Korean Circ J 2022; 52:844-846. [PMID: 36347520 PMCID: PMC9643568 DOI: 10.4070/kcj.2022.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sung Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
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