North Carolina Stroke Prevention and Treatment Facilities Survey

Abstract

Background and Purpose —North Carolina is situated in the “stroke belt” region of the United States, an area of the country with a particularly high incidence of cerebrovascular disease. The North Carolina Stroke Prevention and Treatment Facilities Survey was carried out to determine the availabilities of a variety of stroke prevention and treatment services throughout the state. The purpose of the present study was to determine how widely recombinant tissue-type plasminogen activator (rtPA) has been adopted for the treatment of patients with acute ischemic stroke and to determine the characteristics of the medical facilities in the state offering this therapy. Methods —A single-page survey was mailed to the medical center directors of each inpatient medical facility in North Carolina. Data collected included questions related to the availability of selected basic and advanced diagnostic tests and procedures, stroke prevention and treatment programs and services (community stroke awareness program, acute stroke identification program, acute stroke team, stroke rtPA protocol, stroke care map, neurologist), and facilities (Stroke Acute Care Unit or equivalent). Results —Responses were obtained from all 125 inpatient medical facilities in North Carolina. rtPA stroke protocols were adopted in 54 facilities located in 46 of the state’s 100 counties. Seventy-four percent of the state’s population resides in counties with hospitals providing rtPA treatment. Compared with facilities not offering rtPA, those with rtPA protocols more commonly sponsored stroke community awareness programs (41% versus 17%, P =0.003) and more frequently had an organized stroke team (31% versus 8%, P =0.001), used stroke care maps (56% versus 17%, P <0.001), had rapid stroke identification programs (33% versus 6%, P <0.001), or had a Stroke Acute Care Unit or its equivalent (33% versus 7%, P <0.001). Neurologists were available in 78% of the facilities offering rtPA compared with 38% in facilities without rtPA protocols ( P <0.001). Conclusions —These data show that this new therapy for ischemic stroke is potentially available to a high proportion of the state’s citizens based on their county of residence. However, other services that may improve outcomes and reduce stroke-related costs (eg, stroke teams, stroke units, care maps) are not being widely used, even in centers providing treatment with rtPA. The simple methodology used in this study is potentially applicable in other states and permits targeting of selected centers for development of stroke treatment capabilities.

Facilities Available in European Hospitals Treating Stroke Patients

“…In the North Carolina survey, the response rate was 100%, but the area covered was much smaller, the cover letter was signed by a local stroke expert and the deputy director of the State Department of Health and Human Services, the answers were not anonymous, and the questionnaire was shorter. 16,17 Facilities selected for AHW were only those evaluated as important or absolutely necessary by Ͼ50% of the experts and in centers where only 50% of the requirements were met in each category qualified for this. This definition implies that the level of requirement for AHW can be considered as very low and obviously a suboptimal level of care.…”

An Intervention to Improve Procedure Education for Internal Medicine Residents

“…8 The new requirements will almost certainly cause further deterioration of procedure skills, possibly increasing risk to patients. The alternative, that General Internists will refer such procedures to invasive radiologists, is not a widely available option, 22 especially in the smaller centers where Internists most commonly perform them. 2 If Internists entering Hospitalist practices or subspecialty fellowships are not trained to do basic invasive procedures during their residencies, those programs will have to create structures to supply the needed training.…”

Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

“…In Ontario hospitals, a SU existed in only 4% of acute institutions [28]. In the United States many hospitals do not have the necessary infrastructure and organisation for acute stroke care [29][30][31]. Thus, there is an urgent need to implement new SUs worldwide [32,33].…”