| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Stroke. 2000;31:66.)
© 2000 American Heart Association, Inc.
Original Contributions |
North Carolina Stroke Prevention and Treatment Facilities Survey
Statewide Availability of Programs and Services
From the Departments of Medicine (Neurology) (L.B.G.) and Surgery (L.A.H, R.L.), Duke Center for Cerebrovascular Disease (L.B.G.), Center for Clinical Health Policy Research (L.B.G.), and Center for Clinical Effectiveness (L.A.H., R.L.), Duke University, and the Durham VA Medical Center (L.B.G.), Durham, NC.
Correspondence to Larry B. Goldstein, MD, Box 3651, Duke University Medical Center, Durham, NC 27710. E-mail golds004{at}mc.duke.edu
Background/Purpose—The aim of this study was to determine the statewide availability of facilities and programs for stroke prevention and treatment to identify underserved regions and target educational efforts.
Methods—A single-page survey was mailed to the directors of each inpatient medical facility in North Carolina. Data collected included the availability of selected diagnostic tests, programs, and services. Facilities were categorized as providing basic (emergency department, brain CT, treatment with rtPA, transthoracic echocardiography, carotid ultrasonography, cerebral angiography, carotid endarterectomy) or advanced (basic services plus brain MRI, MR angiography, transesophageal echocardiography, transcranial Doppler ultrasonography, interventional radiology) services. The availability of other programs and services, including having a neurologist on staff, organized anticoagulation clinics, inpatient rehabilitative services, diffusion-weighted MRI, community awareness and rapid stroke identification programs, stroke teams, stroke acute care units or an equivalent, and the use of stroke-care maps, were also determined.
Results—Complete responses were obtained from all of the state’s 125 inpatient medical facilities. Overall, 97% of the state’s population resided in counties with a hospital providing at least some stroke prevention or treatment procedures or services. Full basic services were provided by 23 facilities located in 19 of the state’s 100 counties and were available to 52% of the state’s population based on county of residence; advanced services were provided by 8 facilities located in 7 counties and were available to 26% of the state’s population based on county of residence. Stroke-care maps were used in 83% of basic or advanced centers versus 23% of other hospitals (P<0.001), stroke teams were organized in 48% versus 12% (P=0.001), stroke units or equivalents were available in 61% versus 9% (P<0.001), rapid patient identification programs were in place in 57% versus 9% (P<0.001), and community awareness programs were in place in 57% versus 21% (P=0.005).
Conclusions—Only 52% of the state’s population reside in counties with hospitals providing full basic services; by expanding these services to only 6 additional facilities and thereby encompassing the state’s 50 most populous counties, this proportion would be increased to 84%. Services that may improve outcomes and reduce costs (eg, stroke teams, stroke units, care maps) are not widely used, even in centers with full basic capabilities. Targeting educational efforts to these centers could improve the overall level of stroke care for the majority of the state’s population. The study serves as a model that can be applied to other states and regions.
Key Words: cerebrovascular disorders • data collection • diagnosis • emergency medical services • prevention
This article has been cited by other articles:
 |
|
 |
|
  L. A. Sposato, M. M. Esnaola, R. Zamora, M. C. Zurru, O. Fustinoni, G. Saposnik, on behalf of ReNACer Investigators, and the Argentinian Neurological Society Quality of Ischemic Stroke Care in Emerging Countries: The Argentinian National Stroke Registry (ReNACer) Stroke, November 1, 2008; 39(11): 3036 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Leys, E. B. Ringelstein, M. Kaste, W. Hacke, and for the Executive Committee of the European Stroke Facilities Available in European Hospitals Treating Stroke Patients Stroke, November 1, 2007; 38(11): 2985 - 2991. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Leira, J. K. Pary, P. H. Davis, K. J. Grimsman, and H. P. Adams Jr Slow Progressive Acceptance of Intravenous Thrombolysis for Patients With Stroke by Rural Primary Care Physicians Arch Neurol, April 1, 2007; 64(4): 518 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. I. Gropen, P. J. Gagliano, C. A. Blake, R. L. Sacco, T. Kwiatkowski, N. J. Richmond, D. Leifer, R. Libman, S. Azhar, M. B. Daley, et al. Quality improvement in acute stroke: The New York State Stroke Center Designation Project. Neurology, July 11, 2006; 67(1): 88 - 93. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. L. Birbeck, D. S. Zingmond, X. Cui, and B. G. Vickrey Multispecialty stroke services in California hospitals are associated with reduced mortality Neurology, May 23, 2006; 66(10): 1527 - 1532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force Members, L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Stroke, March 1, 2005; 36(3): 690 - 703. [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Schwamm, A. Pancioli, J. E. Acker III, L. B. Goldstein, R. D. Zorowitz, T. J. Shephard, P. Moyer, M. Gorman, S. C. Johnston, P. W. Duncan, et al. Recommendations for the Establishment of Stroke Systems of Care: Recommendations From the American Stroke Association's Task Force on the Development of Stroke Systems Circulation, March 1, 2005; 111(8): 1078 - 1091. [Full Text] [PDF]
|
|
|
|
|
|
V. C. Douglas, D. C. Tong, L. A. Gillum, S. Zhao, L. M. Brass, J. Dostal, and S. C. Johnston Do the Brain Attack Coalition's criteria for stroke centers improve care for ischemic stroke? Neurology, February 8, 2005; 64(3): 422 - 427. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Camilo and L. B. Goldstein Statewide Assessment of Hospital-Based Stroke Prevention and Treatment Services in North Carolina: Changes Over the Last 5 Years Stroke, December 1, 2003; 34(12): 2945 - 2950. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Kidwell, T. Shephard, S. Tonn, B. Lawyer, M. Murdock, W. Koroshetz, M. Alberts, G. J. Hademenos, and J. L. Saver Establishment of primary stroke centers: A survey of physician attitudes and hospital resources Neurology, May 13, 2003; 60(9): 1452 - 1456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Silliman, B. Quinn, V. Huggett, and J. G. Merino Use of a Field-to-Stroke Center Helicopter Transport Program to Extend Thrombolytic Therapy to Rural Residents Stroke, March 1, 2003; 34(3): 729 - 733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. Wattigney, J. B. Croft, G. A. Mensah, M. J. Alberts, T. J. Shephard, P. B. Gorelick, D. S. Nilasena, D. C. Hess, M. D. Walker, D. F. Hanley Jr, et al. Establishing Data Elements for the Paul Coverdell National Acute Stroke Registry: Part 1: Proceedings of an Expert Panel Stroke, January 1, 2003; 34(1): 151 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ruland, P. B. Gorelick, M. Schneck, D. Kim, C. G. Moore, S. Leurgans, and A. Bhardwaj Acute Stroke Care in Illinois: A Statewide Assessment of Diagnostic and Treatment Capabilities * Editorial Comment: A Statewide Assessment of Diagnostic and Treatment Capabilities Stroke, May 1, 2002; 33(5): 1334 - 1340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Micieli, A. Cavallini, and S. Quaglini Guideline Compliance Improves Stroke Outcome: A Preliminary Study in 4 Districts in the Italian Region of Lombardia Stroke, May 1, 2002; 33(5): 1341 - 1347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Holloway, B. G. Vickrey, C. Benesch, J. A. Hinchey, J. Bieber, M. D. Hill, and C. Zahn Development of Performance Measures for Acute Ischemic Stroke Editorial Comment Stroke, September 1, 2001; 32(9): 2058 - 2074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Gillum and S. C. Johnston Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes Stroke, September 1, 2001; 32(9): 2137 - 2142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Alberts, G. Hademenos, R. E. Latchaw, A. Jagoda, J. R. Marler, M. R. Mayberg, R. D. Starke, H. W. Todd, K. M. Viste, M. Girgus, et al. Recommendations for the Establishment of Primary Stroke Centers JAMA, June 21, 2000; 283(23): 3102 - 3109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Holloway, C. Benesch, and S. R. Rush Stroke prevention: Narrowing the evidence-practice gap Neurology, May 23, 2000; 54(10): 1899 - 1906. [Abstract] [Full Text] [PDF]
|
|