We conclude that differences in patient satisfaction levels could be influenced by different perspectives on prioritized skills.

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ObjectivesRegional medical coordination is essential for health-system reform in Japan, and the quality of healthcare at the regional level is of great interest. Regional differences in the quality of healthcare for cardiovascular diseases have been pointed out in previous research, and we aimed to clarify regional factors that influence the quality.DesignInsurance claims database study.SettingPatients of acute care in Japan.ParticipantsJapanese patients included in the national Diagnosis Procedure Combination (DPC) databases who admitted to hospitals with diagnosis of acute myocardial infarction (AMI) from April 2016 to March 2019.Main outcome and measuresUsing the national DPC databases, risk-adjusted mortality (RAM) in each secondary medical area (SMA) was derived as an indicator for the quality of the healthcare for patients with AMI. Factors associated with RAM were analysed using the partial least squares (PLS) regression model.ResultsThere is a wide variation in RAM in the SMAs; the maximum value was 0.593 and the minimum value was 1.445. The PLS regression identified two components positively correlated with RAM. The first component (Component 1) positively correlates with the proportion of the elderly within the population and negatively correlates with the number of medical facilities per area, the population density, and the intra-SMA access to centres with a high volume of emergency percutaneous coronary interventions (ePCI). The second component (Component 2) positively correlates with the number of medical facilities per area and negatively correlates with the number of physicians per person and the intra-SMA access to centres with a high volume of ePCI.ConclusionThere was wide regional variation in the quality of in-hospital AMI treatments. Results suggested the degree of rurality, the sufficiency of medical resources, the access to high-volume ePCI centres, and coordination of healthcare delivery were associated with healthcare quality for AMI patients.

BACKGROUND Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-folds: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories. METHODS We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories. RESULTS The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group. CONCLUSION The trajectory of the proportion of PCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends.