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 During the study, the increase in the number of hospitals certified
as primary stroke centers was more than twice as high in states with
stroke legislation as in states without similar laws.
At these hospitals, a dedicated stroke-focused program staffed by
professionals with special training delivers emergency therapy
rapidly and reliably.
All hospitals should be able to see patients with stroke, but PSC
certification attests to quality of care, said lead author Dr. Ken
Uchino of the Cleveland Clinic.
“It takes money and effort to organize quality care,” he told
Reuters Health by email. “Sometimes a hospital is so small that the
facility does not expect many patients with stroke to arrive.
Sometimes the resources to provide quality care are not available,
such as radiology technicians on call to run a CT scanner 24 hours a
day or a specialist physician in the community.”
U.S. organizations first began certifying stroke centers in 2003.
Some states developed their own certification programs, and many
passed laws requiring ambulance personnel to take an acute stroke
patient directly to a certified center, bypassing hospitals that are
not certified.
These laws seem to have encouraged more hospitals to get
certification, according to a paper online now in the journal
Stroke.
Between 2009 and 2013, states with stroke legislation had a 16%
increase in PSC certification, compared to a 6% increase in states
without similar legislation.
“I think if a hospital administrator realizes that an ambulance
might bypass his or her hospital because it is not stroke-certified,
there is an incentive to organize stroke care in the hospital and
have stroke center certification,” Uchino said.
By 2013, about a third of short-term adult general hospitals with
emergency departments in the U.S. were certified as primary stroke
centers, he said. But growth rates have varied by state, and by 2013
there were still three states with only one certified center, he
said.
Out of 4,640 general hospitals with emergency rooms in the country,
1,505 have been certified as primary stroke centers following action
by state legislatures. But the proportion of stroke centers by state
still varied from as low as 4% in Wyoming, which has no stroke
legislation, to 100% in Delaware, which does have stroke laws.
“Massachusetts, Florida, and New Jersey, which passed stroke
legislation in 2004, had 74 to 97% of the hospitals certified as
stroke centers by 2013,” Uchino said.
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Larger, more urban hospitals in states with higher economic output
are most likely to be certified as primary stroke centers, the
researchers found.
Patients brought to a certified stroke center have a better chance
of survival than those brought elsewhere, Uchino said.
Almost all large hospitals can and should be stroke centers, and
small hospitals still need help to improve, he said.
“Small hospitals still can become stroke centers, but they had to be
creative with how they pulled resources together,” said Dr. Lee H.
Schwamm of Massachusetts General Hospital and Harvard Medical School
in Boston.
“Every community should have at least one” primary stroke center,
Schwamm, who was not part of the new study, told Reuters Health by
phone. “The real challenge is how do I ensure equitable access for
people all over the country.”
Small rural hospitals may struggle to have access to stroke
expertise, but that may be overcome with telemedicine, if stroke
experts elsewhere are available by remote link, he said.
Individual advocacy can make a difference in access to stroke care,
he said.
“If you live in a community, go look up your hospital online and see
if it’s participating in a national stroke quality program and if it
is certified by a state or national body,” Schwamm said. “If your
hospital isn’t certified or doesn’t have this, pressure your
hospital, ask your doctor why not.”
SOURCE: http://bit.ly/1Hh5KvP
Stroke 2015.
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