Shumei Man1, Jesse D Schold1, Ken Uchino2. 1. From the Clinical Neuroscience Institute, Miami Valley Hospital, Wright State University Boonshoft School of Medicine Dayton, OH (S.M.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (J.D.S.); and Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (K.U.). 2. From the Clinical Neuroscience Institute, Miami Valley Hospital, Wright State University Boonshoft School of Medicine Dayton, OH (S.M.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (J.D.S.); and Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (K.U.). uchinok@ccf.org.
Abstract
BACKGROUND AND PURPOSE: An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. METHODS: We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. RESULTS: Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission (P<0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. CONCLUSIONS: Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.
BACKGROUND AND PURPOSE: An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. METHODS: We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. RESULTS: Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission (P<0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. CONCLUSIONS: Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.
Authors: J Margo Brooks Carthon; Heather Brom; Matthew McHugh; Marguerite Daus; Rachel French; Douglas M Sloane; Robert Berg; Raina Merchant; Linda H Aiken Journal: Nurs Res Date: 2022 Jan-Feb 01 Impact factor: 2.381
Authors: Robert Mikulik; Michal Bar; David Cernik; Roman Herzig; Rene Jura; Lubomir Jurak; Jiri Neumann; Daniel Sanak; Svatopluk Ostry; Petr Sevcik; Ondrej Skoda; David Skoloudik; Daniel Vaclavik; Ales Tomek Journal: Eur Stroke J Date: 2021-04-12
Authors: Hannah Gardener; Erica C Leifheit; Judith H Lichtman; Yun Wang; Kefeng Wang; Carolina M Gutierrez; Maria A Ciliberti-Vargas; Chuanhui Dong; Sofia Oluwole; Mary Robichaux; Jose G Romano; Tatjana Rundek; Ralph L Sacco Journal: J Am Heart Assoc Date: 2019-01-08 Impact factor: 5.501
Authors: Xin Tong; Linda Schieb; Mary G George; Cathleen Gillespie; Robert K Merritt; Quanhe Yang Journal: Prev Chronic Dis Date: 2021-02-18 Impact factor: 2.830
Authors: Krislyn M Boggs; Brian T Vogel; Kori S Zachrison; Janice A Espinola; Mohammad K Faridi; Rebecca E Cash; Ashley F Sullivan; Carlos A Camargo Journal: J Am Coll Emerg Physicians Open Date: 2022-02-28
Authors: Hong-Kyun Park; Seong-Eun Kim; Yong-Jin Cho; Jun Yup Kim; Hyunji Oh; Beom Joon Kim; Jihoon Kang; Keon-Joo Lee; Min Uk Jang; Jong-Moo Park; Kwang-Yeol Park; Kyung Bok Lee; Soo Joo Lee; Ji Sung Lee; Juneyoung Lee; Ki Hwa Yang; Ah Rum Choi; Mi Yeon Kang; Eric E Smith; Philip B Gorelick; Hee-Joon Bae Journal: Eur Stroke J Date: 2019-05-24