State stroke legislation increases U.S. primary stroke centers

A hospital that has been certified as a Primary Stroke Center (PSC) has met specific standards for delivering prompt stroke care. To be eligible, hospitals must meet several criteria, including setting up a dedicated stroke-focused program staffed by medical professionals trained in stroke care.

Researchers analyzed all acute care hospitals in the United States. Of a total 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, amounting to about one-third of hospitals nationwide.

'State legislative action has had a great impact on increasing the number of primary stroke centers that have been certified in the United States,' said Ken Uchino, M.D., the study's lead author and associate professor of medicine (neurology) and research director of the Cleveland Clinic in Ohio.

State action usually includes 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 such as time-dependent clot-busting treatment can be delivered more reliably and rapidly.

Four key factors that play a role in the certification of primary stroke centers are stroke legislation, urbanization, state economic output and larger hospital size, researchers found.

'Of these factors, the most important one that we have the ability to change is state legislation, and that has a greater impact on increasing the percentage of certified hospitals compared to states without legislation,' Uchino said.

In this study from 2009 to 2013, researchers found states with stroke legislation had greater increases in PSCs (16 percent) than states without stroke legislation (6 percent).

In 2000, the movement to establish certified stroke centers to improve stroke care began with the Brain Attack Coalition's recommendations, researchers said.

The Joint Commission and the American Heart Association/ American Stroke Association began certifying hospitals as PSCs in 2003. At present, 74 percent of the primary stroke centers have been certified by The Joint Commission and the AHA/ASA. About 20 percent have been certified by state organizations and 6 percent by other organizations, researchers said. Massachusetts and Delaware are the top states with the highest percentage of certified PSCs. In Massachusetts, 97 percent of the state's 63 hospitals have been certified as PSCs, and in Delaware, 100 percent of the state's five hospitals have been certified as PSCs in 2013.

The highest proportion of primary stroke certification was in the Northeastern United States, according to researchers who analyzed both U.S. Census Bureau data and American Hospital Association data. Hospitals in the South and Midwest had significantly reduced odds of becoming a PSC.

Vermont and New Hampshire, near Massachusetts, had a low percentage of PSCs, according to the analysis. In Vermont, only one of 14 state hospitals hospital achieved certification while three of 26 New Hampshire hospitals, achieved certification, likely related to rural geography and lack of stroke legislation. In Texas, primary stroke center certification increased from 12 percent to 34 percent following passage of state stroke legislation in 2009.

Future research will focus on the clinical outcome of patients receiving care in designated primary stroke centers following legislative action, Uchino said.