TY - JOUR ID - 4415 TI - Institutional Variance in Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction in Korea, Japan, and Taiwan JO - International Journal of Health Policy and Management JA - IJHPM LA - en SN - AU - Yamana, Hayato AU - Lee, Seyune AU - Lin, Yi-Chieh AU - Yoon, Nan-He AU - Fushimi, Kiyohide AU - Yasunaga, Hideo AU - Cheng, Shou-Hsia AU - Kim, Hongsoo AD - Data Science Center, Jichi Medical University, Shimotsuke, Japan AD - Institute of Health and Environment, Seoul National University, Seoul, South Korea AD - Department of Healthcare Administration, College of Medicine, I-Shou University, Kaohsiung, Taiwan AD - Division of Social Welfare and Health Administration, Wonkwang University, Iksan, South Korea AD - Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan AD - Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan AD - Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan Y1 - 2023 PY - 2023 VL - 12 IS - Issue 1 SP - 1 EP - 8 KW - Acute myocardial infarction KW - Administrative Data KW - East Asia KW - Hospital Performance DO - 10.34172/ijhpm.2023.6796 N2 - 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 2016 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 17 351 patients from 160 Korean hospitals, 29 804 patients from 660 Japanese hospitals, and 10 863 patients from 104 Taiwanese hospitals included in the analysis. Inpatient mortality rates were 6.3%, 7.3%, and 6.0% in Korea, Japan, and Taiwan, respectively. After adjusting for patient and hospital characteristics, Taiwan had the lowest variation in mortality (ICC, 1.8%), followed by Korea (2.2%) and then Japan (4.5%). The measured hospital characteristics explained 38%, 19%, and 9% 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. UR - https://www.ijhpm.com/article_4415.html L1 - https://www.ijhpm.com/article_4415_e9b4aacc6d0a5f679ea300746cfbbe3b.pdf ER -