1. ** Kim Division of Chronic Disease Control, Korea Centers for Disease Control and Prevention Study on public interest of Republic of Korea(ROK)-type HPH ‘ Regional Cardio- CerebroVascular Center (RCCVC)’ 21 st International Conference on HPH 2013.5.22-24

2. Introduction  Health 2020  Health for all & health inequality  Leadership and participatory governance for health  HPH  Disease prevention, Health education, Health promotion  RCCVC  11 centers(1 center/region)  Budget : $10 million/center  Purpose  Decrease of mortality and disability due to cardio-cerebrovascular diseases (AMI, Stroke) 2

3. Structure and Major functions of RCCVC 3 Regional Cardiocerebrovascular Center -24-hours Residence of CP team -Development and operation of critical pathway (CP) -Installation of Stroke unit (SU) -Early rehabilitation within 48 hours -Cardiac rehabilitation -Building a cooperative system with subcenters and clinical networks at community -24-hours Residence of CP team -Development and operation of critical pathway (CP) -Installation of Stroke unit (SU) -Early rehabilitation within 48 hours -Cardiac rehabilitation -Building a cooperative system with subcenters and clinical networks at community -Inpatient man to man customized education -Inpatient small-group education by specialist -Follow-up service after discharge -Outpatient education -case management -Development of skilled manpower -Community preventive services -Inpatient man to man customized education -Inpatient small-group education by specialist -Follow-up service after discharge -Outpatient education -case management -Development of skilled manpower -Community preventive services Prevention and Management Center Prevention and Management Center Cardiovascular Center Cardiovascular Center Steering committee Steering committee Regional committee for cardicerebrovascular disease management Regional committee for cardicerebrovascular disease management Cardiocerebral Rehabilitation Center Cardiocerebral Rehabilitation Center Cerebrovascular Center Cerebrovascular Center

4. Process of patient education and management  Continuous education & healthcare service 4 Duringhospitalization Afterdischarge 1.Risk assessment 2.Planning for education 3.1:1 education based on the assessment 4.Request for specialist’s health class 1m, 3m, 12m F/U by phone call Check of Risk factor and health management status Outpatient education Education Nurse Specialist Education Nurse Request for Individualized education Patient’ informed consent Small-group education Duringhospitalization Education Nurse specialist

5. Purpose/Methods  Purpose  Development of a desirable management model and strategies for RCCVC through an analysis of public interest  Methods  Data collection : questionnaire (7 domains, total 37 items, 7- point Likert scale), mail-survey  Study population : 180 employees  Statistical analysis : SPSS 2.0 5

6. Results (1) CategoriesMean ± SD F1Provision of high quality comprehensive services5.96 ± 0.69 F2Organization operation control5.89 ± 0.81 F3Quality improvement of manpower and organization5.53 ± 0.92 F4Legal and institutional basis5.73 ± 0.87 F5Complements against market failures5.81 ± 0.92 F6Emergency medical service5.11 ± 1.40 F7Cost control5.17 ±1.10 The average score5.71 ± 0.69 6  Public interest by domains  Provision of high quality comprehensive services > organization operation control > complements against market failures …

7. Results (2)  Comparison of public interest among subcenters  Prevention & Management center > cardiovascular center > cerebrovascular center > cardiocerebral Rehabilitation center 7 Mean score

8. Conclusions  The services of RCCVC have relatively high public interest  24-hours specialist’s resident-on-call  1:1-customized education for inpatients, F/U-service after discharge, and outpatient education  Campaigns to raise early symptoms awareness and CPR training to the community, etc.  It calls for continuous financial and technical support to sustain these comprehensive (pre-/in-/post-hospital) interventions 8

9. Challenges  Establishment of hospital-based disease management model  Connection and integration of treatment-rehabilitation- preventive healthcare service  Expansion of regional cardiocerebrovascular center  Ongoing/planned Research  Calculating severity-adjusted mortality rates  Evaluating the cost-effectiveness of RCCVC’s prevention programs 9

10. Signs of a heart attack and ‘Call 119’ 10

11. Signs of a stroke and ‘Call 119’ 11

12. Thank you for your attention 12