Abstract 3424: Comprehensive and Primary Stroke Centers: Outcomes from the SouthEast Texas Regional Advisory Committee
Background: Collaboration among the different levels of stroke care centers is essential to population coverage of the nation’s most debilitating disease. The prevalence of stroke in Southeast Texas is higher than the national average. Consequently, the state mandated Regional Advisory Committee (RAC) has targeted inter-institutional stroke care collaboration to benefit its service area. Regional hospitals are required to submit data on stroke performance in order to differentiate care capabilities and to ensure quality at each care level. This investigation analyzed the outcomes of Support (level 3), Primary (level 2), Comprehensive stroke care facilities (level 1).
Methods: Three and a half years of regional hospital data (21,994 patient cases) from the Solucients® data base was reviewed. Panel data was analyzed using STATA 11.0 software. Univariate and multivariable techniques were employed to analyze outcomes against institutional designations.
Results: For non-acute stroke, MSDRGs 64-68 statistically significant associations were found between length of stay (p> 0.000, coef= 1.06), 30 day readmission (p> 0.005, coef= 0.32), mortality (p> 0.031, coef= 0.0196) with Comprehensive stroke centers having comparable to slightly higher rates, seen in the low coefficients. This is likely reflective of the higher severity cared for by tertiary referral centers and needs to be further investigated. For acute-stroke, MSDRGs 61-63 (stroke with thrombolytics) no differences in outcomes were found: 30 day readmission- p> 0.071, coef= 0.062. Mortality- p> 0.38, coef= 0.022, and length of stay- p> 0.882, coef= -0.079. Thrombolytic administration rates were 2.7%, 3.3%, 9.3% at stroke support, Primary level, and Comprehensive centers, respectively.
Conclusions: Care differences existed across the three different stroke capability institutional classifications, but not in the expected directionality. Rationale for the contrary findings may be found in the illness severity make-up inherent to each level of stroke care, in the accuracy of self-reported care capable status, or the sensitive accuracy of the data set. Further research is needed. This is the first investigation to look at quantifiable differences in stroke outcomes according to institutional stroke care capability.
- © 2012 by American Heart Association, Inc.