Stroke care delivery before vs after JCAHO stroke center certification

Stradling, Dana; Yu, Wengui; Langdorf, Mark I.; Tsai, Fong Y.; Kostanian, Varoujan; Hasso, Anton N.; Welbourne, Susan; Schooley, Y.; Fisher, Marc; Cramer, Steven C.

doi:10.1212/01.wnl.0000252930.82140.65

Cited by 51 publications

(52 citation statements)

References 4 publications

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“…Moreover, prior studies have reported that stroke centers are more likely to admit patients with hemorrhagic strokes, which are associated with higher mortality as compared to strokes with an ischemic etiology. 7,8 Indeed, we found a similar pattern, in which nearly 60% (4,193/7,243) of hemorrhagic stroke patients in New York were admitted to a stroke center during our study period. In the absence of randomized controlled trials, controlling for treatment patterns is often difficult and assessments of mortality outcomes may be biased given the presence of treatment selection.…”

Section: Commentsupporting

confidence: 72%

“…[5][6][7][8] To date, only one study in Finland has reported lower 1-year stroke case-fatality associated with stroke centers. 26 Our study extends the findings from this prior study, as systems of stroke care in the U.S. may differ substantially from other national healthcare systems (especially those with universal health coverage).…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…Prior studies have largely focused on stroke processes of care, such as treatment timeline and use of thrombolytic therapy. [5][6][7][8] There is comparably less information on whether or not better care at stroke centers affects acute or long-term mortality. 9 Therefore, our goal was to evaluate the association between admission to stroke centers for acute ischemic stroke and mortality.…”

mentioning

confidence: 99%

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Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Xian¹,

Holloway²,

Chan³

et al. 2012

Survey of Anesthesiology

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Context-Although stroke centers are widely accepted and supported, little is known about their impact on patient outcomes.Objective-To examine the association between admission to stroke centers for an acute ischemic stroke and mortality.Design, Setting, and Participants-Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n=30,947) between 2005 and 2006 at designated stroke centers and non-designated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential pre-hospital selection bias. Patients were followed for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n=39,409) or acute myocardial infarction (n=40,024) at designated stroke centers and nondesignated hospitals.Main Outcome Measure-Thirty-day all-cause mortality.Correspondence: Ying Xian, MD, PhD; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705; Tel: (585) Fax: (919) 668-7058; ying.xian@duke.edu. AUTHOR CONTRIBUTIONS Dr Xian had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Previous Presentation:This study was presented in part at the 2010 American Heart Association Quality of Care and Outcomes Research Conference, Washington, DC, May 20, 2010 Role of the Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHA and AHRQ.Disclaimer: This study used a linked SPARCS-SSADMF database. The interpretation and reporting of these data are the sole responsibility of the authors. Results-Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with greater use of thrombolytic therapy (4.8% vs. 1.7%; adjusted difference 2.2%, 95% CI, 1.6% to 2.8%; P<0.001) and lower 30-day all-cause mortality (10.1% vs. 12.5%; adjusted mortality difference: −2.5%, 95% CI, −3.6% to −1.4%; P<0.001). Differences in mortality also were observed at all time points, including at 1-day, 7-day, and 1-year follow-up. Moreover, the outcome differences were specific to stroke, as stroke centers and non-stroke centers had similar 30-day all-cause mortality rates among those with acute myocardial infarction (adjusted mortality difference: +0.3%, 95% CI, −0.5% to 1.0%; P=0.50) and/or gastrointestinal hemorrhage (adjusted mortality difference: +0.1%, 95% CI, −0.9% to 1.1%; P=0.83). NIH Public AccessConclusions-Admission to a designated stroke center for acute isc...

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Section: Commentsupporting

confidence: 72%

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

mentioning

confidence: 99%

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Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Xian¹,

Holloway²,

Chan³

et al. 2012

Survey of Anesthesiology

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“…Those hospitals achieving PSC certification have been shown to have significant increases in IV thrombolysis rates as well as improved 30-day mortality and readmission outcomes. [27][28][29][30][31][32][33] Thus, the efforts by these 2 hospitals to achieve and maintain PSC status likely contributed to the abrupt rise in tPA use observed in the community. In previous studies, there have been conflicting data concerning sex differences in tPA use.…”

mentioning

confidence: 99%

Emerging temporal trends in tissue plasminogen activator use

et al. 2016

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Objective: To explore temporal trends in tissue plasminogen activator (tPA) administration for acute ischemic stroke (AIS) in a biethnic community without an academic medical center and variation in trends by age, sex, ethnicity, and stroke severity.Methods: Cases of AIS were identified from 7 hospitals in the Brain Attack Surveillance in Corpus Christi (BASIC) project, a population-based surveillance study between January 1, 2000, and June 30, 2012. tPA, demographics, and stroke severity as assessed by the NIH Stroke Scale (NIHSS) were ascertained from medical records. Temporal trends were explored using generalized estimating equations, and adjustment made for age, sex, ethnicity, and NIHSS. Interaction terms were included to test for effect modification.Results: There were 5,277 AIS cases identified from 4,589 unique individuals. tPA use was steady at 2% and began increasing in 2006, reaching 11% in subsequent years. Stroke severity modified temporal trends (p 5 0.003) such that cases in the highest severity quartile (NIHSS . 8) had larger increases in tPA use than those in lower severity quartiles. Although ethnicity did not modify the temporal trend, Mexican Americans (MAs) were less likely to receive tPA than nonHispanic whites (NHWs) due to emerging ethnic differences in later years.Conclusions: Dramatic increases in tPA use were apparent in this community without an academic medical center. Primary stroke center certification likely contributed to this rise. Results suggest that increases in tPA use were greater in higher severity patients compared to lower severity patients, and a gap between MAs and NHWs in tPA administration may be emerging. Neurology ® 2016;87:2184-2191 GLOSSARY AIS 5 acute ischemic stroke; BASIC 5 Brain Attack Surveillance in Corpus Christi; ED 5 emergency department; EMS 5 emergency medical services; GAM 5 generalized additive models; GEE 5 generalized estimating equations; ICD-9 5 International Classification of Diseases-9; IQR 5 interquartile range; IRB 5 internal review board; MA 5 Mexican American; NHW 5 non-Hispanic white; NIHSS 5 NIH Stroke Scale; PSC 5 primary stroke centers; RR 5 relative rate; tPA 5 tissue plasminogen activator.Stroke is a leading cause of death and long-term adult disability in the United States. 1,2 Due to reductions in stroke mortality and increased life expectancy, the prevalence of stroke is climbing and predicted to increase by 20.5% by 2030, with the largest increase among Hispanic men (29%). 1 Disparities exist in stroke care in the United States with differences in tissue plasminogen activator (tPA) use based on sex and race-ethnicity demonstrated in academic settings. [3][4][5][6][7] Temporal trends show that tPA use has more than doubled at large, high-volume academic hospitals since the early 2000s, with data suggesting that treatment gaps based on age and race are narrowing. [8][9][10] Yet there is a paucity of information concerning trends in community hospitals, which have been shown to exhibit different trends than academic centers....

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“…Longitudinal studies had smaller study populations. In nine studies a small population was studied more extensively (Simons et al, 2002;Stradling et al, 2007;Paccioni et al, 2008;Awa et al, 2010;Kim et al, 2010;Sack et al, 2010;al Awa et al, 2011a;al Awa et al, 2011b). These studies were done to gain more insights in how accreditation is perceived and what subsystems and cultural variables are affected.…”

Section: Study Approachmentioning

confidence: 99%

The value of external peer review in oncology : evaluating the impact on cancer services in Dutch hospitals

Kilsdonk¹

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Stroke care delivery before vs after JCAHO stroke center certification

Cited by 51 publications

References 4 publications

Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Emerging temporal trends in tissue plasminogen activator use

The value of external peer review in oncology : evaluating the impact on cancer services in Dutch hospitals

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