Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization

Who gives a fuck about provided care you blithering idiots? RESULTS are what you should be measuring; 30 day deaths, tPA full efficacy, 100% recovery. My god, the stupidity involved in most of stroke.
http://stroke.ahajournals.org/content/48/2/412?etoc=

Shumei Man, Margueritte Cox, Puja Patel, Eric E. Smith, Mathew J. Reeves, Jeffrey L. Saver, Deepak L. Bhatt, Ying Xian, Lee H. Schwamm, Gregg C. Fonarow

https://doi.org/10.1161/STROKEAHA.116.014426

Stroke. 2017;48:412-419

Originally published December 22, 2016

• Article
• Figures & Tables
• Supplemental Materials
• Info & Metrics

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

---

Abstract

Background and Purpose—Primary stroke center (PSC) certification was established to identify hospitals providing evidence-based care for stroke patients. The numbers of PSCs certified by Joint Commission (JC), Healthcare Facilities Accreditation Program, Det Norske Veritas, and State-based agencies have significantly increased in the past decade. This study aimed to evaluate whether PSCs certified by different organizations have similar quality of care and in-hospital outcomes.

Methods—The study population consisted of acute ischemic stroke patients who were admitted to PSCs participating in Get With The Guidelines-Stroke between January 1, 2010, and December 31, 2012. Measures of care quality and outcomes were compared among the 4 different PSC certifications.

Results—A total of 477 297 acute ischemic stroke admissions were identified from 977 certified PSCs (73.8% JC, 3.7% Det Norske Veritas, 1.2% Healthcare Facilities Accreditation Program, and 21.3% State-based). Composite care quality was generally similar among the 4 groups of hospitals, although State-based PSCs underperformed JC PSCs in a few key measures, including intravenous tissue-type plasminogen activator use. The rates of tissue-type plasminogen activator use were higher in JC and Det Norske Veritas (9.0% and 9.8%) and lower in State and Healthcare Facilities Accreditation Program certified hospitals (7.1% and 5.9%) (P<0.0001). Door-to-needle times were significantly longer in Healthcare Facilities Accreditation Program hospitals. State PSCs had higher in-hospital risk-adjusted mortality (odds ratio 1.23, 95% confidence intervals 1.07–1.41) compared with JC PSCs.

Conclusions—Among Get With The Guidelines-Stroke hospitals with PSC certification, acute ischemic stroke quality of care and outcomes may differ according to which organization provided certification. These findings may have important implications for further improving systems of care.