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European Journal of Applied Sciences – Vol. 10, No. 3
Publication Date: June 25, 2022
DOI:10.14738/aivp.103.12341. Vichairuangthum, K., Jarujittipant, P., & Veerayannon, K. (2022). An Association Between Administrative Factors and Mortality in
ST-Segment Elevation Myocardial Infarction Patients of Hospitals in Thailand. European Journal of Applied Sciences, 10(3). 156-167.
Services for Science and Education – United Kingdom
An Association Between Administrative Factors and Mortality in
ST-Segment Elevation Myocardial Infarction Patients of Hospitals
in Thailand
Kitigon Vichairuangthum M.D. Ph.D.
Management Program, Faculty of Political Science
North Bangkok University, Thailand
Division of Cardiovascular disease, Royal Heart Center
Huahin Hospital, Phrachuap Khiri Khan, Thailand
Division of Cardiovascular disease, Royal Heart Center
Suranaree university of Technology Hospital
Nakhon Ratchasima, Thailand
Pisamai Jarujittipant Ph.D.
Management Program, Faculty of Political Science
North Bangkok University, Thailand
Kietchai Veerayannon Ph.D.
Management Program, Faculty of Political Science
North Bangkok University, Thailand
ABSTRACT
This descriptive study aimed to study an association between the level of readiness
of administrative factors and the mortality rate of patients with acute ischemic
heart disease of hospitals in Thailand, Target population were 1,180 hospitals that
serving heart disease in Thailand. Data were collected by using a questionnaire. A
total of 1,022 response data were obtained. Administrative factors were analyzed
using descriptive statistics and correlation was analyzed by multiple regression
analysis (MRA) methods. The results showed that the administrative factors which
consisted of personnel, finance, supporting, and management factors had overall
average readiness at a high level (x̄= 3.34, S.D. = 0.27). Except budget sufficiency
was at a low level (x̄= 2.43, S.D. = 0.43). All factors were significantly related to the
mortality rate, as follows: management factor (Adjusted R2 = 0.433), personnel
factor (Adjusted R2 = 0.231), supporting factor (Adjusted R2 = 0.092) and financial
factor (Adjusted R2 = 0.035). Therefore, Thai Ministry of Public Health should
provide adequate support for administrative factors especially in terms of
management, personnel, and budget sufficiency.
Keywords: Administrative Factors, Mortality, ST segment elevation myocardial
infarction, Referral system, Thailand
INTRODUCTION
Coronary heart disease is an acute life-threatening emergency and a major public health
problem in the world and Thailand. According to statistics from the World Health Organization
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Vichairuangthum, K., Jarujittipant, P., & Veerayannon, K. (2022). An Association Between Administrative Factors and Mortality in ST-Segment
Elevation Myocardial Infarction Patients of Hospitals in Thailand. European Journal of Applied Sciences, 10(3). 156-167.
URL: http://dx.doi.org/10.14738/aivp.103.12341
(WHO)in 2012, there were 7.4 million deaths worldwide from ischemic heart disease or 12.2%
of all causes of death. In 2018, the number of deaths from coronary heart disease rose to 17.9
million, accounting for 31 % of the world's causes of death [1]. While data from the Thai
Ministry of Public Health found that Thailand in 2017, the rate of death from coronary heart
disease were 31.8 per 100,000 population, an increase from 2012, which had a mortality rate
of only 23.45 per 100,000 population [2], which is a trend of increasing deaths from heart
disease.
Acute ischemic heart disease is caused by a condition in which blood clots occlude in the
coronary artery. This results in myocardial infarction, often presenting with immediate
symptoms. Especially if abnormal electrocardiogram (ECG) abnormalities are found in the ST
segment raised at least 2 contiguous leads, which is specifically called ST Elevation Myocardial
Infarction (STEMI) [3]. If the clogged artery is not opened in a short time, there will cause a
chance of sudden death [4]. Treatment according to the guidelines of the European Heart
Association 2017 edition [5] and the Heart Association of Thailand 2020 edition [3] have
determined that this group of patients should receive coronary artery
catheterization (Percutaneous Coronary Intervention; PCI) within 120 minutes [6], as if treated
later than that time myocardial muscle may cause permanent injury and death [7,8,9]. Because
most hospitals in Thailand do not currently have cardiac catheterization rooms especially in
rural areas so an effective referral system is therefore very important. The Thai Ministry of
Public Health divided the area of responsibility of the cardiac referral system into 13 health
service areas according to the criteria of the Thai National Health Security Office (NHSO) [10]
as shown in table 1, In 2018, the overall mortality rate of patients with acute STEMI was 9.84
%, even passing the Key Performance Index (KPI) target (less than 10 %), but still very high
and tends to be higher from 2017, which found a mortality rate of 9.63 %. In 2018, there were
nearly half (6 areas) of all service areas still experienced a higher mortality rate than the criteria
(area 2; 10.94 %, area 3; 10.27 %, area 4; 12.79 %, area 5; 11.99 %, area 9; 11.72 %, area 10;
13.07%) [11].
The referral system for acute STEMI patients cannot operate effectively without the readiness
of administrative factors including Personnel (Man), Finance (Money), Supporting Factors
(Material) and Management (Method), which are critical factors. Methodical management of
these resource utilization ensures efficient and effective work [12,13,14]. From the above data
reflects the problems, and research questions of referral system for patients with acute
STEMI of hospitals in Thailand, Is there an administrative factors readiness? And what
administrative factors affect the effectiveness of the mortality rate of the acute STEMI referral
system of hospitals in Thailand? The study results as a guideline for the development and
improves the referral system for acute STEMI patients in Thailand.