Acute stroke care in Illinois: a statewide assessment of diagnostic and treatment capabilities.
OBJECTIVE
To define areas for quality improvement in acute stroke care, a statewide assessment of preparedness for acute stroke diagnosis and treatment was carried out among 202 acute receiving hospitals in Illinois.


METHODS
Medical directors or their designees completed a 1-page survey form that addressed availability of personnel, diagnostic technology, and organized programs for the treatment of acute stroke patients at their facility. In the analysis, acute care receiving hospitals in the Greater Chicago Metropolitan Area (GCMA) (Cook, Dupage, Lake, Will, and Kane counties) were compared with those in the remainder of the state.


RESULTS
Of the acute care receiving hospitals, 91% responded to the survey. Overall, 99% had an emergency room receiving facility, 98.3% had a CT scanner, and slightly >70% had a recombinant tissue plasminogen activator (r-TPA) protocol. We found that 93.2% of residents in Illinois lived in a county with at least 1 acute care facility with an r-TPA treatment protocol. However, many of the non-GCMA receiving hospitals did not have a neurologist or a neurosurgeon available. Furthermore, specialized stroke diagnostic technology (eg, transcranial Doppler, diffusion-weighted MRI, MR angiography) was generally lacking in both the GCMA and non-GCMA, as were stroke community awareness programs and acute care stroke teams.


CONCLUSIONS
Stroke is a preventable and treatable disease. However, there are barriers to stroke care that are based on the availability of personnel, diagnostic technology, and programs. A systematic approach to the organization, implementation, and maintenance of services could improve outcome for stroke patients and reduce the public health burden of this deadly disease.
Ruland
Sean
S
Department of Neurological Sciences, Section of Cerebrovascular Disease and Neurologic Critical Care, Rush Medical College, Chicago, Ill 60612, USA. sruland@rush.edu
Gorelick
Philip B
PB
Schneck
Michael
M
Kim
Duk
D
Moore
Charity G
CG
Leurgans
Sue
S
D000208:Acute Disease; D002641:Chicago; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D015898:Tomography Scanners, X-Ray Computed / Q000600:supply & distribution; D000078329:Workforce
D010959:Tissue Plasminogen Activator