State Legislation Yields More Primary Stroke Centers

Megan Brooks

June 29, 2015

The number of primary stroke centers (PSCs) in the United States is up sharply in the last decade, and state legislation to enable them is a driving factor, a new study shows.

From 2009 to 2013, states with stroke legislation had greater increases in PSCs (16%) than states without stroke legislation (16% vs 6%; P = .0067), according to the study, published online June 18 in Stroke.

"State legislative action has had a great impact on increasing the number of primary stroke centers that have been certified in the United States," lead investigator Ken Uchino, MD, associate professor (neurology) and research director at the Cleveland Clinic in Ohio, said in a statement.

The Joint Commission (JC) and the American Heart Association/American Stroke Association began certifying hospitals as PSCs in 2003. A hospital that has been certified as a PSC has met specific standards for delivering reliable and rapid stroke care, including time-dependent thrombolysis by a dedicated team of doctors trained in stroke care.

State action may include implementing policies for emergency medical services (EMS) to bypass the nearest hospital and send ambulances directly to certified PSCs so that standard acute stroke therapies can be delivered more reliably and rapidly.

The study by Dr Uchino's group finds that, as of December 2013, there were 1505 certified PSCs in 1574 sites in the United States, representing 32% of the 4640 short-term adult general hospitals with emergency departments. Roughly three quarters (74%) were certified by the JC, 20% by state, and 6% by other organizations.

The proportion of PSCs varied widely across the 50 states and the District of Columbia, ranging from 4% in Wyoming to 100% in Delaware, with an overall median of 25%. The densely populated Northeast had the highest proportion of PSCs, with 59% of hospitals certified, followed by the West (32%), South (30%), and Midwest (24%).

The 18 states that had legislation in designating stroke centers and regulating stroke triage had a higher percentage of PSCs (median, 43%; range, 13% to 100%) than the other states (median, 13%; range, 4% to 75%; P < .001).

In multivariable logistic regression analysis, the number of hospital beds, urbanization, gross domestic product, and state stroke legislation were independently associated with stroke center designation.

This analysis "demonstrates the important role of state legislation in the stroke system of care in the United States," the researchers say. "State-level stroke center designation, usually accompanied by immediate mandate or future plans to divert patients with acute stroke to designated centers, had a powerful impact on the number of PSCs, and presumably, the availability of acute stroke care that meets basic clinical standards defined by guidelines."

The American Heart Association funded the study. The authors have disclosed no relevant financial relationships.

Stroke. 2015;46:1903-1908. Abstract

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