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

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

doi:10.1161/STROKEAHA.116.014426

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

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

Research output: Contribution to journal › Article › peer-review

37 Scopus citations

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.

Original language	English (US)
Pages (from-to)	412-419
Number of pages	8
Journal	Stroke
Volume	48
Issue number	2
DOIs	https://doi.org/10.1161/STROKEAHA.116.014426
State	Published - Feb 1 2017
Externally published	Yes

Keywords

certification
ischemic stroke
outcome
primary stroke center
quality of care

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialized Nursing

Access to Document

10.1161/STROKEAHA.116.014426

Cite this

@article{ae0f4f31b5704df2821a464e533d2d49,

title = "Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization",

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.",

keywords = "certification, ischemic stroke, outcome, primary stroke center, quality of care",

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

note = "Funding Information: Sources of Funding The American Heart Association receives a portion of the fees paid by hospitals to the Joint Commission for Primary Stroke Certification. The GWTG-Stroke program is currently supported in part by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, manuscript preparation, or approval of this study. Publisher Copyright: {\textcopyright} 2016 American Heart Association, Inc.",

year = "2017",

month = feb,

day = "1",

doi = "10.1161/STROKEAHA.116.014426",

language = "English (US)",

volume = "48",

pages = "412--419",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization

AU - Man, Shumei

AU - Cox, Margueritte

AU - Patel, Puja

AU - Smith, Eric E.

AU - Reeves, Mathew J.

AU - Saver, Jeffrey L.

AU - Bhatt, Deepak L.

AU - Xian, Ying

AU - Schwamm, Lee H.

AU - Fonarow, Gregg C.

N1 - Funding Information: Sources of Funding The American Heart Association receives a portion of the fees paid by hospitals to the Joint Commission for Primary Stroke Certification. The GWTG-Stroke program is currently supported in part by a charitable contribution from Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership and the American Heart Association Pharmaceutical Roundtable. GWTG-Stroke has been funded in the past through support from Boehringer-Ingelheim and Merck. These funding agencies did not participate in design or analysis, manuscript preparation, or approval of this study. Publisher Copyright: © 2016 American Heart Association, Inc.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - 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.

AB - 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.

KW - certification

KW - ischemic stroke

KW - outcome

KW - primary stroke center

KW - quality of care

UR - http://www.scopus.com/inward/record.url?scp=85007233481&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85007233481&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.116.014426

DO - 10.1161/STROKEAHA.116.014426

M3 - Article

C2 - 28008094

AN - SCOPUS:85007233481

SN - 0039-2499

VL - 48

SP - 412

EP - 419

JO - Stroke

JF - Stroke

IS - 2

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this