Stroke Legislation Impacts Distribution of Certified Stroke Centers in the United States

Abstract

This study included only those that were categorized as general hospitals with emergency departments. Rehabilitation, geography, pediatric, long-term care, and federal government hospitals (Veterans and military hospitals) were excluded. For hospitals with multiple sites, the entry in Background and Purpose-The number of certified primary stroke centers (PSCs) have increased dramatically during the past decade in the United States We aimed to understand the factors affecting PSC distribution in the United States, including the impact of state stroke legislation. Methods-PSCs certified by national organization or state until December 2013 were searched from available databases. The proportion of PSC among short-term general hospitals in each state was calculated and factors affecting its distribution were analyzed. Results-By the end of 2013, the proportion of PSC varied from 4% to 100% among the 50 states and District of Columbia.The 18 states that had legislation in designating stroke centers and regulating stroke triage had higher PSC percentages (median, 43%; range, 13%-100%) than the remaining states (median, 13%; range, 4%-75%; P<0.001). State stroke legislation, urbanization, state economic output, and larger hospital size independently increased the likelihood of a hospital to be stroke certified. the American Hospital Association Database was used as the unit of 1 hospital. The proportion of PSC-certified hospitals among all hospitals was calculated. The Core Based Statistic Area assignment for each hospital was used as a marker of urbanization and was drawn from the American Hospital Association Database. Core-based statistical areas were defined by the US Office of Management and Budget as metropolitan division (a core with a population of at least 2.5 million with surrounding areas), metropolitan statistical area (urbanized area that has a population of at least 50 000 and surrounding areas), micropolitan statistical area (1 urban cluster that has a population of at least 10 000, but <50 000 and surrounding areas), and rural area. 12 We used the region designation by the US Census Bureau as Northeast, Midwest, South, and West. 13 Statistical AnalysisThe data were analyzed using JMP 10.0 (SAS Inc, Cary, NC ). Eighteen states established legislation in designating stroke centers and some of them implemented policies for emergency medical services to route patients with acute stroke to PSC-certified hospitals. The legislation status in each state is shown in Table 1. States with stroke legislation had higher PSC proportion than those states with no stroke legislation (Figure 1). The percentage of PSC certified hospitals in states with no stroke legislation ranged from 4% in Wyoming to 75% in DC, with a median of 13% (Table I in the onlineonly Data Supplement). In the states with stroke legislation, the percentage of PSCs ranged from 13% in North Dakota to 100% in Delaware, with a median of 43% (P<0.001; Table I in the online-only Data Supplement). When the 50 states and the District of Columbia were stra...

Presentation, Evaluation, Management, and Outcomes of Acute Stroke in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…It is important to keep in mind that these practices remain suboptimal even in HIC hospitals, especially in rural areas. For example, a 2013 study conducted in the United States revealed that the number of hospitals that have organized stroke unites varied widely across the states, ranging from 4% in Wyoming to 100% in Delaware, with an overall median of 25% [20]. This confirms the continuous need to improve and build on our knowledge of implementing evidence-based practices for stroke care across all country income groups.…”

Stroke unit legislation—Mandating a uniform standard of care?

“…The literature provides evidence that a top-down approach improves access to stroke care. 4,5 Introduction of relevant legislation in some American states substantially increased the proportion of hospitals with certified primary stroke centers, compared with states without such legislation (median: 43% and 13% of hospitals, respectively; p < 0.001). 4 Stroke legislation was also associated with increased availability of access to certified primary stroke centers.…”

“…4,5 Introduction of relevant legislation in some American states substantially increased the proportion of hospitals with certified primary stroke centers, compared with states without such legislation (median: 43% and 13% of hospitals, respectively; p < 0.001). 4 Stroke legislation was also associated with increased availability of access to certified primary stroke centers. 4 Elsewhere, organized systems such as certification (Europe) 6 and high-level government overview (Canada) 7 are also used to formalize stroke care.…”

“…4 Stroke legislation was also associated with increased availability of access to certified primary stroke centers. 4 Elsewhere, organized systems such as certification (Europe) 6 and high-level government overview (Canada) 7 are also used to formalize stroke care. A nuanced approach to legislation could help avoid controversy, as occurred during early debate over treatment with TPA, thereby facilitating the process.…”

Endovascular Stroke Therapy

“…34 In addition, geographic disparities in stroke centers exist with the majority of facilities located in large urban settings primarily in states with existing stroke legislation. 35 Therefore, health care policies implemented at a regional and national level will be necessary to increase the availability and distribution of stroke centers in the future. In comparison, there are more than 1,000 primary stroke centers (PSCs) in the United States, but less than half of these facilities offer around-the-clock mechanical thrombectomy.…”