Koji Iihara1, Kunihiro Nishimura2, Akiko Kada3, Jyoji Nakagawara4, Kazunori Toyoda5, Kuniaki Ogasawara6, Junichi Ono7, Yoshiaki Shiokawa8, Toru Aruga9, Shigeru Miyachi10, Izumi Nagata11, Shinya Matsuda12, Koichi B Ishikawa13, Akifumi Suzuki14, Hisae Mori15, Fumiaki Nakamura16. 1. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kiihara@hsp.ncvc.go.jp. 2. Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 3. Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, Osaka, Japan. 4. Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Osaka, Japan. 5. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 6. Department of Neurosurgery, Iwate Medical University, Iwate, Japan. 7. Chiba Cardiovascular Center, Chiba, Japan. 8. Department of Neurosurgery, Kyorin University, Tokyo, Japan. 9. Showa University Hospital, Tokyo, Japan. 10. Department of Neurosurgery, Nagoya University, Nagoya, Japan. 11. Department of Neurosurgery, Nagasaki University, Nagasaki, Japan. 12. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. 13. Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. 14. Research Institute for Brain and Blood Vessels, Akita, Japan. 15. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. 16. Department of Healthcare Epidemiology, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Abstract
BACKGROUND: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions. METHODS: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009. RESULTS: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001). CONCLUSION: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.
BACKGROUND: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions. METHODS: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009. RESULTS: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001). CONCLUSION: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.