Medical Research: What is the background for this study? What are the main findings?
Dr. Uchino: Stroke center designation started in 2003 and more hospitals have been certified as primary stroke centers over time. We asked the question how many are certified now? What are the characteristics of the hospitals that are certified?
In 2013, nearly a third (23%) of acute short-term adult general hospitals with emergency departments were certified as stroke centers. 74% of the stroke centers were certified by the Joint Commission, a non-profit organization that certifies health care facilities and programs. 20% were certified by state health departments. States varied in percentages of hospitals that were certified, ranging from 4% in Wyoming to 100% in Delaware.
Not unexpectedly larger hospitals and hospitals in urban locations were more likely to be certified as stroke centers.
But a hospital being located in a state with so-called “stroke legislation” more than tripled the chance of being a certified stroke centers, even accounting for other factors. These states passed legislation to promote stroke centers and mandated stroke patients to be preferentially transported to qualified hospitals.
Medical Research: What should clinicians and patients take away from your report?
Dr. Uchino: More hospitals are being designated as stroke centers. Certification can be accomplished in smaller hospitals with appropriate support such as telemedicine and care protocols. Know whether your local hospital is stroke-certified.
Changes in policy at state level (stroke legislation) impacts availability of good stroke care. Remind your legislator the importance of stroke and stroke care.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Uchino: Designation of stroke centers and quality improvement programs appear to have improved stroke care and patient outcomes. Further research needs to show what we can do next to improve systematic care, whether higher level of comprehensive stroke center designation improves outcomes, and whether these changes have had impact at population level.
Uchino K, et al “Stroke legislation impacts distribution of certified stroke centers in the United States”
Stroke 2015; DOI: 10.1161/STROKEAHA.114.008007.
MedicalResearch.com Interview with: Dr. Ken Uchino, MD, Cleveland Clinic Main Campus, & Cleveland, OH 44195 (2015). States With Stroke Legislation Have More Certified Stroke Centers