The burden of acute myocardial infarction after a regional cardiovascular center project in Korea

OBJECTIVE: The aim of this study was to examine the impact of a government-directed regional cardiovascular center (RCVC) project on the length of stay (LOS) and medical costs due to acute myocardial infarction (AMI). DESIGN: A retrospective claim data review. SETTING: Forty hospitals including four RCVCs in Korea. PARTICIPANTS: A total of 1469 AMI patients who visited a RCVC in two regions between February 2009 and December 2011. INTERVENTIONS: RCVC project has been fostering specialized center by region for management of cardiovascular disease. It has built a system that could receive intensive care quickly within 3 h when disease occurred. MAIN OUTCOME MEASURES: Changes in the LOS and cost were evaluated using the difference-in-differences (DIDs) method combined with propensity score matching (1:1) and multilevel analysis with adjustment for patient's and institutional factors. RESULTS: The net effect of RCVC project implementation showed decline of LOS (-0.71 days) and total medical costs (-797 US dollars) by DID. After the RCVC project, the LOS for patients with AMI hospitalized in a RCVC was decreased by 8.9% (β = -0.094, P = 0.041) compared with patients hospitalized in a hospital not designed as a RCVC. Compared with costs before the RCVC project, they were decreased by 11.5% (β = -0.122, P = 0.004). CONCLUSIONS: We provided evidence regarding the change in the societal burden due to AMI after regionalization. Although there was a reduction of LOS and direct medical costs reported in limited number of regionalized hospitals, in the long term we can anticipate an expanding impact in all regionalized hospitals.