Research Activities, October 2013
Stroke patients are more likely to receive tissue plasminogen activator at Joint Commission-certified stroke centers
Patient Safety and Quality
Primary stroke centers (PSCs) are designed to provide rapid diagnosis and treatment of patients who have suffered a stroke. These centers are certified by the Joint Commission and deliver stroke therapies, such as recombinant tissue plasminogen activator (rt-PA).
A new study found that patients evaluated at PSCs were more likely than patients at non-certified hospitals to receive rt-PA therapy. Data were obtained from a large, inpatient database on patients discharged with a diagnosis of ischemic stroke from 2004 to 2009. The admitting hospital was also identified as either a certified or non-certified PSC. Whether or not a patient received intravenous rt-PA was determined. Of 323,228 patients studied, 63,145 patients (19.5 percent) were evaluated at PSCs. During the study period, the number of PSCs increased from 112 in 2004 to 673 at the end of 2009. Overall, the rate of patients receiving rt-PA was 3.1 percent.
More patients received rt-PA at PSCs (6.7 percent) compared to those at non-PSCs (2.2 percent). During the 5-year period, treatment with rt-PA increased from 1.4 percent to 3.3 percent at non-PSCs and from 6.0 percent to 7.6 percent at PSCs. PSC certification was significantly associated with a patient receiving rt-PA treatment. Odds of rt-PA therapy were higher at PSCs for all patient age groups, hospital location and teaching status, and volume of stroke cases each year. The study was supported in part by AHRQ (HS18362 and T32 HS13852).
See "Joint Commission primary stroke centers utilize more rt-PA in the Nationwide Inpatient Sample," by Michael T. Mullen, M.D., Scott E. Kasner, M.D., Michael J. Kallan, M.S., and others in the May 26, 2013, Journal of the American Heart Association 2(2) [Epub ahead of print].