Deans' stroke musings: Impact of Stroke Center Certification on Mortality After Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, August 28, 2017

Impact of Stroke Center Certification on Mortality After Ischemic Stroke

You lazy fucking bastards, ignoring reporting on the outcome of 100% recovery. Do primary stroke centers have better recovery metrics? Without an answer to that we may as well shut down those centers that don't report complete results. 30day deaths? tPA full efficacy? 100% recovery? We need to stop talking about 'care' and focus on results you blithering idiots.
http://stroke.ahajournals.org/content/48/9/2527?etoc=

The Medicare Cohort From 2009 to 2013

Shumei Man, , Ken Uchino

https://doi.org/10.1161/STROKEAHA.116.016473

Stroke. 2017;48:2527-2533

Originally published July 26, 2017

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Abstract

Background and Purpose—An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality.

Methods—We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups.

Results—Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission (P<0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817–0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968–0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848–0.943), 30-day (HR, 0.904; 95% CI, 0.892–0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898–0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911–0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892–0.907) than non-SCs.

Conclusions—Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.