Abstract 192: Impact of Primary Stroke Center Certification on Rt-PA Utilization
Introduction: In 2003, the Joint Commission (JC) began certifying hospitals as Primary Stroke Centers (PSC). One of the key components of PSC certification is preparedness to administer rt-PA. Data regarding the impact of stroke center certification on rt-PA utilization is limited. We sought to compare rates of rt-PA use at JC-certified PSC’s to non-PSC’s, and to evaluate the impact of certification on rt-PA treatment rates, at the hospital level.
Methods: This analysis utilized the MEDPAR database, which is a claims-based dataset containing every fee-for-service Medicare-eligible hospital discharge in the U.S. Ischemic stroke cases were defined via ICD-9 code of 433, 434, or 436. Thrombolysis use was defined as an ICD-9 procedure code of 99.1. Study interval was FY 2001-2010. Hospitals were stratified by ischemic stroke case volume. Date of original certification was obtained from the JC. For the temporal analysis, rt-PA utilization rates at each PSC were evaluated by quarter for three years pre- and post-certification. For comparison, every non-PSC was assigned a date for analysis, taken from PSC certification dates within the same case-volume class.
Results: Of 3,275 acute care hospitals included in this analysis, 668 were JC certified PSCs. In FY 2010, the overall rt-PA utilization rate for the Medicare population was 2.2%, however utilization rates were significantly higher at PSC’s than non-PSC’s, 4.9% vs 1.5 %(P<0.0001). The difference between PSC’s and non-PSC’s rates was correlated with case load. Non-stroke centers admitting 10 or fewer stroke patients per quarter (n=1,058) treated 0.7% with rt-PA vs. low-volume PSCs (n=23) which treated 6.7% (p=0.0003). Non-PSC’s admitting more than 75 stroke patients per quarter (n=54) treated at a rate more similar to their PSC counterparts, (n=113), 3.2% vs. 4.6% (p=0.0031). The temporal relationship between certification and rt-PA utilization is displayed in the >Figure. Rt-PA utilization rates at PSC’s increased at a higher rate than non-PSC’s, 0.13% per quarter vs 0.02% per quarter (p<0.0001).
Discussion: Compared to non-PSCs,JC certified PSCs utilize rt-PA on a higher proportion of IS patients, although the differences are the most striking in low-volume hospitals. Hospitals that sought PSC certification had similar baseline utilization rates to non-PSC’s. PSC’s increased rt-PA utilization rates prior to certification and this increase continued for three years post-certification. A limitation of this analysis is that “drip and ship” patients are not included for PSCs or non-PSCs.
- © 2012 by American Heart Association, Inc.