What fucking stupidity. You don't measure 'care, you measure results; like 100% recovery. When will we get survivors in charge and actually solve stroke rather than tip toeing around the edges?
Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals
- 1Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- 2Department of Neurology, Roxanna Todd Hodges Comprehensive Stroke Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- 3Department of Neurology, UCLA Comprehensive Stroke Center, Los Angeles, CA, United States
- 4Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States
- 5Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, United States
- 6Los Angeles County Department of Public Health, Los Angeles, CA, United States
- 7Department of Neurology, Stanford Stroke Center, School of Medicine, Stanford University, Palo Alto, CA, United States
- 8National Institutes of Health, Bethesda, MD, United States
Background and Purpose:
Primary stroke
center (PSC) certification is associated with improvements in stroke
care and outcome. However, these improvements may reflect a higher
baseline level of care delivery in hospitals eventually achieving
certification. This study examines whether advancements in acute stroke
care at PSCs are due to certification or factors intrinsic to the
hospital.
Methods:
Data was obtained from the
Field Administration of Stroke Therapy-Magnesium (FAST-MAG) trial with
participation of 40 Emergency Medical System agencies, 315 ambulances,
and 60 acute receiving hospitals in Los Angeles and Orange Counties.
Subjects were transported to one of three types of destinations: PSC
certified hospitals (PSCs), hospitals that were not PSCs at time of
enrollment but would later become certified (pre-PSCs), and hospitals
that would never be certified (non-PSCs). Metrics of acute stroke care
quality included time arrival to imaging, use of intravenous tPA, and
arrival to treatment.
Results:
Of 1,700 cases, 856(50%) were
at certified PSCs, 529(31%) were at pre-PSCs, and 315 (19%) were at
non-PSCs. Mean (SD) was 33min (±76.1) at PSCs, 47(±86.6) at pre-PSCs,
and 49(±71.7) at non-PSCs. Of 1,223 cerebral ischemia cases, rate of tPA
utilization was 43% at PSCs, 27% at pre-PSCs, and 28% at non-PSCs. Mean
ED arrival to thrombolysis was 71(±32.7) at PSC, 98(±37.6) at pre-PSC,
and 95(±45.0) at non-PSCs. PSCs had improved time to imaging (p = 0.014), percent tPA use (p < 0.001), and time to treatment (p = 0.003).
Conclusions:
Stroke care at hospitals prior to PSC certification is equivalent to care at non-PSCs.
Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00059332.
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