Study: Get thee to a stroke center

Hospitals with designated stroke centers are associated with up to 20 percent higher survival rate for patients with ischemic stroke and significantly greater use of acute stroke therapy. That is the conclusion of a study appearing today in the Journal of the American Medical Association which compares treatment and outcomes in stroke care between hospitals in New York State.

"The basic premise of stroke centers and stroke care – that coordinated care delivered around a specific disease can likely improve outcomes – is widely accepted," said University of Rochester Medical Center (URMC) neurologist Robert Holloway, M.D., M.P.H., a co-author of the study. "However, there has been limited empirical evidence demonstrating that admission to a stroke center is associated with lower mortality. This study shows that designated stroke centers not only have a greater adherence to evidence based practices but they also save lives."

The concept for comprehensive and coordinated stroke care was formalized in the recommendations of the Brain Attack Coalition in 2000. The goal was to emulate an approach to care similar to trauma centers by getting stoke patients to facilities where the specialists and infrastructure are in place to evaluate and treat them quickly.

In 2003, the Joint Commission began to certify stroke centers based on a set of 11 criteria which include coordinated neurological, surgical, imaging, laboratory, and emergency personnel and services, established protocols, 24-hour coverage, and a commitment to track and improve outcomes. Approximately 700 of the nation's 5,000 acute care hospitals are currently designated as stroke centers.

Some states, including New York, have subsequently established their own designation programs for stroke care. The New York State Stroke Center Designation program is a collaboration between the state's Department of Health and the American Heart Association. By the end of the study, 104 of the state 244 hospitals were designated as stroke centers.

"The idea of designated stroke centers was born after research concluded that many lives could be saved if our medical system had the necessary personnel, equipment and organization to treat stroke patients rapidly and efficiently," said Ying Xian, M.D., Ph.D., a previous graduate student in Health Services Research and Policy with URMC Department of Community and Preventive Medicine and now a fellow with the Duke Clinical Research Institute and lead author of the study. "Our study was designed to evaluate whether or not access to quality and coordinated stroke care had an impact on processes of stroke care and patient outcomes."

The authors used data from the New York Statewide Planning and Research Cooperative System, a comprehensive set of patient data for every hospital admission in the state, and the Social Security Administration Death Master File. The study examined 2 years of data from 2005 to 2006 during which 30,947 patients were admitted to hospitals in New York State for acute ischemic stroke – the most common type of stroke that occurs when the blood supply to the brain is blocked. Roughly half of those patients were treated at state-designated stroke centers.