Abstract WMP100: State Based Stroke Center Designation Increases their Availability and Thrombolytic Administration Rates
Background: The Joint Commission (JC) recently proposed criteria for certification of comprehensive stroke centers (CSCs), which have capabilities for stroke care in addition to those of primary stroke centers (PSCs). CSCs may be ideal facilities to care for patients ineligible for intravenous thrombolysis (IT). We sought to assess the availability of PSCs and CSCs and variability in their designation mechanisms in the United States (US).
Methods: Numbers of designated stroke centers were determined from state Departments of Health (DOH) and JC listings and DOH surveys. These were integrated with 2010 US Census bureau data. Minimum hospital volumes for annual procedures and disease specific admissions required for CSCs (IT for 25 stroke patients, care of 20 subarachnoid hemorrhage patients, endovascular embolization of 15 cerebral aneurysms and surgical clipping of 10 aneurysms) were extracted per state from the 2009 Nationwide Inpatient Sample (NIS).
Results: Projected number of CSCs are low (.28+/-0.54 per million capita). States with their own DOH based PSC designation had significantly higher numbers of all stroke centers per million capita (7+/-2 vs 3+/-2, p<0.001), primarily constituted by DOH designated PSCs. These states also had a non-significant trend towards higher numbers of CSCs per million capita, (0.81+/-0.72 vs 0.18+/-0.47). NIS data demonstrate only 1.6% (82 of 5128) of hospitals meet all 4 volume criteria, with the most deficient item being required aneurysm clippings (3.9%). Among hospitals lacking only 1 of the 4 criteria (n=131), IT volume was the major deficiency (51.8%). States with DOH based PSC designation had significantly higher numbers of hospitals achieving this goal for IT (10.8% vs 3.0%, p<0.001) even after controlling for bed size and teaching status (OR: 1.77; 95% CI: 1.49-2.11).
Conclusion: Projected numbers of CSCs are low. Hospital deficiencies must be investigated in order to meet the public’s needs. States with DOH designation mechanisms have higher numbers of all stroke centers, which administer thrombolysis at higher rates. More widespread adoption of these successful state policies may increase stroke centers’ ability to care for acute ischemic stroke.
- © 2012 by American Heart Association, Inc.