Abstract
BACKGROUND: High patient volumes are associated with better stroke management and outcomes. However, in sparsely populated regions, patients with stroke frequently rely on low-volume hospitals for acute care. This study evaluates the performance of high-performing hospitals among low-volume hospitals and identifies factors contributing to their high performance despite treating fewer stroke cases. METHODS AND RESULTS: We analyzed data from the eighth Acute Stroke Quality Assessment Program in 2018, alongside reimbursement claims and death certificate records, to evaluate stroke care in 248 hospitals across South Korea, including all general and tertiary hospitals. The hospitals treating <100 patients with stroke annually were classified as low-volume. High performance among these hospitals was defined as achieving a defect-free care rate of >75%. The outcome measured was the poststroke 1-year mortality rate. Of 28 572 patients, 2521 (8.8%) were treated in low-volume hospitals, primarily general hospitals outside the capital area. The 1-year mortality rate was significantly higher in low-volume hospitals (24.8%) compared with their high-volume counterparts (17.6%, adjusted P<0.01). High-performing low-volume hospitals exhibited a significantly lower 1-year mortality rate (21.1%) than low-performing hospitals (26.9%, adjusted P=0.036), with no significant difference in the number of hospital beds or annual stroke admissions. High-performing low-volume hospitals were characterized by their location (P=0.048) and a significantly greater number of physicians, particularly neurologists (P=0.010). The presence of neurologists was also associated with a higher defect-free care rate in these hospitals. CONCLUSIONS: This study highlights the status of low-volume hospitals in providing stroke care in areas with limited access to larger medical facilities. It suggests that enhancing acute stroke care performance, particularly through human resource investments, can significantly improve quality and patient outcomes at these hospitals.