title: Organization of a United States county system for comprehensive acute stroke care.
abstract: OBJECTIVE
  Organized systems of care have the potential to improve acute stroke care delivery. The current report describes the experience of implementing a county-wide system of spoke-and-hub stroke neurology receiving centers (SNRC) that incorporated several comprehensive stroke center recommendations.
  
  
  METHODS
  Observational study of patients with suspected stroke of <5 hours duration transported by emergency medical system personnel to an SNRC during the first year of this system.
  
  
  RESULTS
  A total of 1360 patients with suspected stroke were evaluated at 9 hub SNRC, of which 553 (40.7%) had a discharge diagnosis of ischemic stroke. Of these 553, intravenous tissue-type plasminogen activator was administered to 110 patients (19.9% of ischemic strokes). Care at the 6 neurointerventional-ready SNRC was a major focus in which 25.1% (99/395) of the patients with ischemic stroke received acute intravenous or intra-arterial reperfusion therapy, and in which provision of such therapies was less common with milder stroke, older age, and Hispanic origin. The door-to-needle time for intravenous tissue-type plasminogen activator met the <60-minute target in only 25% of patients and was 37% longer (P=0.0001) when SNRC were neurointerventional-ready.
  
  
  CONCLUSIONS
  A stroke system that incorporates features of comprehensive stroke centers can be effectively implemented with substantial rates of acute reperfusion therapy administration. Experiences potentially useful to broader implementation of comprehensive stroke centers are considered.
authors.affiliation: University of California Irvine Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868, USA. scramer@uci.edu
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cramer
authors.forename: Dana
authors.initials: D
authors.lastname: Stradling
authors.forename: David M
authors.initials: DM
authors.lastname: Brown
authors.forename: Ignacio M
authors.initials: IM
authors.lastname: Carrillo-Nunez
authors.forename: Anthony
authors.initials: A
authors.lastname: Ciabarra
authors.forename: Michael
authors.initials: M
authors.lastname: Cummings
authors.forename: Richard
authors.initials: R
authors.lastname: Dauben
authors.forename: David L
authors.initials: DL
authors.lastname: Lombardi
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Traynor
authors.forename: Stephen
authors.initials: S
authors.lastname: Waldman
authors.forename: Ken
authors.initials: K
authors.lastname: Miller
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stratton
mesh_terms: D000367:Age Factors; D000552:Ambulances / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D000554:Ambulatory Care Facilities / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D002140:California; D003695:Delivery of Health Care; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000628:therapy*; D013997:Time Factors