2010 年至 2018 年日本综合卒中中心能力的时间趋势和地域差异。
Temporal trends and geographical disparities in comprehensive stroke centre capabilities in Japan from 2010 to 2018.
机构信息
Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
出版信息
BMJ Open. 2020 Aug 6;10(8):e033055. doi: 10.1136/bmjopen-2019-033055.
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.
目的
综合卒中中心（CSC）的能力与急性卒中院内死亡率的降低有关。然而，目前尚不清楚 CSC 能力是否存在改善趋势，以及医院相关因素如何决定质量的提高。本研究旨在探讨日本 2010 年至 2018 年间 CSC 能力是否发生了变化，以及任何变化是否受到医院特征的影响。
设计
一项基于医院的横断面研究。
地点
我们于 2010 年、2014 年和 2018 年向日本神经外科学会和日本卒中学会的培训机构发送了问卷。
参与者
2010 年有 749 家医院、2014 年有 532 家医院和 2018 年有 786 家医院参加了 J-ASPECT 研究，这是一项针对日本急性卒中治疗能力的全国性调查，旨在正确指定综合卒中中心。
主要观察指标
2010 年、2014 年和 2018 年调查中，采用经过验证的评分系统（CSC 评分：1-25 分）评估 CSC 能力。使用多因素逻辑回归分析检验医院特征的影响。
结果
在所有调查中回复的 323 家医院中，13 项推荐项目的实施有所增加。CSC 评分（中位数和 IQR）分别为 2010 年 16（13-19）、2014 年 18（14-20）和 2018 年 19（15-21）（p<0.001）。有 6 项（如血管内医师、卒中单元和介入覆盖 24/7）的增加幅度≥20%，社区教育的减少幅度≤20%。基线 CSC 评分较低（OR：0.82，95%CI 0.75-0.9）、床位数≥500（OR：3.9，95%CI 1.2-13.0）和卒中医师数（7-9）（OR：2.6，95%CI 1.1-6.3）与 CSC 能力的改善相关，独立于地理位置。
结论
2010 年至 2018 年间，CSC 能力显著提高，主要与血管内治疗和多学科治疗的可用性有关。我们的研究结果可能有助于确定应在哪些医院提高 CSC 能力，以改善特定地区的 CSC 能力。
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