Laws Improve Stroke Treatment

State stroke legislation increases U.S. primary stroke centers




States’ individual stroke legislation plays a compelling role in certifying primary stroke centers (PSC) and improving availability and accessibility of care to acute stroke patients, according to research in the American Heart Association journal Stroke.

A hospital that has been certified as a PSC has met specific standards for delivering prompt stroke care. To be eligible, hospitals must meet several criteria, including setting up a dedicated stroke-focused program staffed by medical professionals trained in stroke care.

Researchers analyzed all acute care hospitals in the United States. Of 4,640 general hospitals with emergency rooms, 1,505 have been certified as PSCs following action by state legislatures, amounting to about one-third of hospitals nationwide.

"State legislative action has had a great impact on increasing the number of primary stroke centers that have been certified in the United States," said Ken Uchino, M.D., the study’s lead author and associate professor of medicine in neurology and research director of the Cleveland Clinic.

Dr. Ken Uchino

State action usually includes implementing policies for emergency medical services to bypass the nearest hospital and send ambulances directly to certified PSCs so that standard acute stroke therapies such as time-dependent, clotbusting treatment can be delivered more reliably and rapidly.

Four key factors that play a role in the certification of PSCs are stroke legislation, urbanization, state economic output and larger hospital size, researchers found.

"Of these factors, the most important one that we have the ability to change is state legislation, and that has a greater impact on increasing the percentage of certified hospitals compared to states without legislation," Uchino said.

In this study from 2009 to 2013, researchers found states with stroke legislation had greater increases in PSCs (16 percent) than states without stroke legislation (6 percent).

In 2000, the movement to establish certified stroke centers to improve stroke care began with the Brain Attack Coalition’s recommendations.

The Joint Commission and the American Heart Association/American Stroke Association began certifying hospitals as PSCs in 2003. At present, 74 percent of the PSCs have been certified by The Joint Commission and the AHA/ASA. About 20 percent have been certified by state organizations and six percent by other organizations, researchers said. Massachusetts and Delaware have the highest percentage of certified PSCs. In Massachusetts, 97 percent of the state’s 63 hospitals have been certified; in Delaware, 100 percent of the state’s five hospitals were certified in 2013.

The highest proportion of primary stroke certification was in the Northeast, according to researchers who analyzed both U.S. Census Bureau data and American Hospital Association data. Hospitals in the South and Midwest had significantly reduced odds of becoming a PSC.

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