1. Nationally Certified Stroke Centers Outperform Self-Attested Stroke Centers in the Florida Stroke Registry
- Author
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Erika Marulanda, Antonio Bustillo, Carolina M. Gutierrez, David Z. Rose, Angus Jameson, Hannah Gardener, Ayham Alkhachroum, Lili Zhou, Hao Ying, Chuanhui Dong, Dianne Foster, Ricardo Hanel, Brijesh Mehta, Maxim Mokin, Nils Mueller-Kronast, Mark Landreth, Charles Sand, Jose G. Romano, Tatjana Rundek, Negar Asdaghi, and Ralph L. Sacco
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: The Florida Stroke Act, signed into law in 2004, set criteria for Comprehensive Stroke Centers (CSC). For a set time period, Florida hospitals were permitted to either receive national certification (NC) or could self-attest (SA) as fulfilling CSC criteria. The aim of this project was to evaluate the quality of ischemic stroke care in NC versus SA stroke centers in Florida, using well-known, guideline-driven ischemic stroke outcome metrics. Methods: A total of 37 CSCs (74% of Florida CSCs) in the Florida Stroke Registry from January 2013 through December 2018 were analyzed, including 19 SA CSCs and 18 NC (13 CSCs and 5 Thrombectomy-Capable Stroke Center). Hospital- and patient-level characteristics and stroke metrics were evaluated, adjusting for demographics, medical comorbidities, and stroke severity. Results: A total of 78 424 acute ischemic stroke cases, 36 089 from SA CSCs and 42 335 from NC CSC/Thrombectomy-Capable Stroke Centers were analyzed. NC centers had older patients (73 [61–83] versus 71 [60–81]; P P P P P P P P =0.001) and more likely to be treated with intravenous tissue-type plasminogen activator within 45 minutes (adjusted odds ratio, 1.61 [95% CI, 1.04–2.50]; P =0.04) compared with SA CSCs. Conclusions: Among Florida-Stroke Registry CSCs, acute ischemic stroke performance and treatment measures at NC centers are superior to SA CSCs. These findings have implications for stroke systems of care in Florida and support legislation updates requiring NC and removal of SA claims.
- Published
- 2023