title: Drive-time proximity to Joint Commission Primary Stroke Centers among North Carolina residents who died of stroke.
abstract: OBJECTIVE
  In developing a statewide system of stroke care, understanding the relative availability of acute stroke care at designated centers for stroke care is essential. In this article, we compare the change in availability of acute stroke care in North Carolina at Joint Commission Primary Stroke Centers (JCPSCs) between 2006 and 2008 by examining the drive-time proximity of the residential address to the nearest JCPSC among people who died of stroke.
  
  
  METHODS
  We assigned geographic coordinates to residential addresses of North Carolinians who died of stroke and to addresses of North Carolina JCPSCs. We calculated the distance within a 40-minute drive from each JCPSC and determined whether the residential addresses of patients who died of stroke were in the areas demarcated by the drive time. In a secondary analysis, we included non-ICPSCs that participate in recognized quality-improvement programs for stroke care.
  
  
  RESULTS
  In 2006, 37% of geocodable residences of patients who died of stroke (3,834 of 10,469) were within a 40-minute drive from a JCPSC. By the end of 2008, this percentage increased to 56% (3,482 of 6,204). Inclusion of other hospitals that participate in recognized quality-improvement programs for acute stroke care increased the 40-minute drive-time coverage to 82% (5,095 of 6,204).
  
  
  CONCLUSIONS
  As an index of the geographic distribution of the stroke burden, we used deaths due to stroke, rather incident strokes. We included several assumptions in our drive-time calculation.
  
  
  CONCLUSIONS
  For many regions of North Carolina in which the stroke burden is high, timely care at JCPSCs for acute stroke is unavailable. To develop a statewide system for acute stroke care in North Carolina, criteria beyond JCPSC certification should be considered for designating hospitals as centers for stroke care.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, USA. andrew.asimos@carolinashealthcare.org
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Asimos
authors.forename: Dianne
authors.initials: D
authors.lastname: Enright
authors.forename: Sara L
authors.initials: SL
authors.lastname: Huston
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Mettam
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000592:standards* / Q000600:supply & distribution*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality*; D013997:Time Factors; D014481:United States