Institutional Variance in Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction in Korea, Japan, and Taiwan

Background  Although there have been studies that compared outcomes of patients with acute myocardial infarction (AMI) across countries, little focus has been placed on institutional variance of outcomes. The aim of the present study was to compare institutional variance in mortality following percutaneous coronary intervention (PCI) for AMI and factors explaining this variance across different health systems.Methods  Data on inpatients who underwent PCI for AMI in ۲۰۱۶ were obtained from the National Health Insurance Data Sharing Service in Korea, the Diagnosis Procedure Combination (DPC) Study Group Database in Japan, and the National Health Insurance Research Database (NHIRD) in Taiwan. Multilevel analyses with inpatient mortality as the outcome and the hierarchical structure of patients nested within hospitals were conducted, adjusting for common patient-level and hospital-level variables. We compared the intraclass correlation coefficient (ICC) and the proportion of variance explained by hospital-level characteristics across the three health systems.Results  There were ۱۷ ۳۵۱ patients from ۱۶۰ Korean hospitals, ۲۹ ۸۰۴ patients from ۶۶۰ Japanese hospitals, and ۱۰ ۸۶۳ patients from ۱۰۴ Taiwanese hospitals included in the analysis. Inpatient mortality rates were ۶.۳%, ۷.۳%, and ۶.۰% in Korea, Japan, and Taiwan, respectively. After adjusting for patient and hospital characteristics, Taiwan had the lowest variation in mortality (ICC, ۱.۸%), followed by Korea (۲.۲%) and then Japan (۴.۵%). The measured hospital characteristics explained ۳۸%, ۱۹%, and ۹% of the institutional variance in Korea, Taiwan, and Japan, respectively.Conclusion  Korea, Japan, and Taiwan had similarly uniform outcomes across hospitals for patients undergoing PCI for AMI. However, Japan had a relatively large institutional variance in mortality and a lower proportion of variation explainable by hospital characteristics, compared with Korea and Taiwan.

Keywords:

Acute myocardial infarction , Administrative Data , East Asia , Hospital Performance