Abstract 2667: Comparative Effectiveness Analysis of Stroke Center Designations on Patient Outcomes
Background: Stroke designation has become increasingly important for administrators and physicians of stroke facilities in recent years. Designation (accreditation, recognition) as a stroke center implies to the community tangible evidence of quality, yet no study has assessed the comparative effectiveness of outcomes for designation in stroke.
Methods: Using 2004 to 2009 for all patients treated for acute ischemic stroke across all 547 hospitals in Texas, we perform a comparative effectiveness analysis. Ischemic strokes include only ICD-9 codes 433-436. De-identified data were obtained from the Texas Health Care Information Collection data files. Hospitals were categorized in three groups: 1) recognition from the American Heart Association Get With the Guidelines Stroke program; 2) accreditation from the Joint Commission as a Primary Stroke Center (PSC), or 3) non-accredited from either of these programs. We compared each of these three subgroups employing various tests for differences and logistic regressions for odds ratios at 95% CI. Outcome measures assessed include mortality rate, average length of stay (ALOS), treatment costs, and use of thrombolysis. We adjusted mortality rates and lytics utilization based on risk mortality, illness severity, and patient age to control for mix and acuity. We calculated lytics rates dividing total cases where lytics were utilized by total ischemic strokes. We adjusted hospital reported charges using a standard cost-charge ratio.
Results: 41 hospitals (7.5%) are recognized by the GWTG Gold or Silver levels, and 77 (14%) were recognized as a Primary Stroke Center. The remainder had neither designation. Of the 275,163 total strokes, 86% were ischemic. ALOS for all patients was 5.3 days, and average hospital costs were $36,529. Average mortality rate was 3.5% and mean lytics utilization was 1.6% across all cases. KW median test confirms that PSC hospitals had significantly lower ALOS compared to the non-accredited group (5.1 days vs. 5.5) and lower costs ($34,428 vs. $38,952). Logistics regressions showed significantly higher lytics rate (OR=3.3) as well as marginally higher mortality rates (OR=1.1). The GWTG subgroup had similar statistically significant results with ALOS (5.1) and costs ($34,792) both being significantly less than the non-accredited group. The odds ratio for lytics usage was exactly twice that of the non-accredited group. Mortality rates however were not significantly different between the two groups.
Conclusion: Accreditation or designation of stroke facilities is associated with more efficient practice of care and improved processes (shorter stays, lower costs, and improved lytics use). Mortality rate however was marginally higher in one of the two accredited subgroups, but not in the other. Results suggest expansion of strengthening and expansion of designation programs.
- © 2012 by American Heart Association, Inc.