Background:
Organized stroke systems of care, including accreditation of hospitals as primary stroke centers (PSC), are meant to improve patient care and compliance with national guidelines. Nationwide, less than a third of eligible hospitals have achieved advanced certification in stroke. We aimed to characterize hospital factors associated with achievement of stroke center certification.
Methods:
We utilized the 2011 American Hospital Association survey to obtain data on hospital characteristics. Only hospitals with ≥ 25 beds and 24-hour emergency departments were evaluated. The Joint Commission (TJC), Healthcare Facilities Accreditation Program and DNV Healthcare websites were used to determine certification status of each hospital as a primary stroke center. All comprehensive SC were considered as PSC. Factors found to be associated with achievement of certification (P<0.010) were evaluated by logistic regression to determine a final model of independent association.
Results:
Of the 3696 hospitals to complete the survey, 3069 fulfilled study criteria, including 908 PSC (31%) and 2161 non-PSC. PSC were larger (mean 354 vs. 136 beds), had busier EDs (56,000 vs. 24,000 visits/year), were more often affiliated with ACGME residency programs (43% vs. 14%), AMA medical schools (51% vs. 21%), TJC-accreditation (95% vs. 65%), inpatient neurological services (94% vs. 46%) and trauma centers (55% VS 38%); and were less likely to be governmental (Federal/State/County 10% vs. 26%) and designated sole community provider (1% vs 9%). Independent hospital characteristics associated with PSC certification were TJC accreditation (OR 3.5, 95%CI 2.4-5.0), sole community provider (OR 0.22, 0.10-0.47), hospital type (governmental vs. non 0.61, 0.44-0.84), increasing size (per quartile in number of beds OR 2.5, 2.1-3.1) and neurological services (OR 3.2, 2.4-4.6).
Conclusions:
PSC hospitals are larger non-governmental hospitals with availability of neurological services. Increasing the low numbers of governmental (i.e. County or State) hospital achievement of PSC may be a potential area of focus.
Using visualisation methods to analyse referral networks within community health care among patients aged 65 years and over
