title: Analysis of a coordinated stroke center and regional stroke network on access to acute therapy and clinical outcomes.
abstract: OBJECTIVE
  Compare access and outcomes in a tertiary care community hospital (Saint Luke's Neuroscience Institute) and its stroke network to hospitals in 3 national databases.
  
  
  METHODS
  Retrospective analysis of ischemic stroke patients (2005, 2007, 2010) in Saint Luke's (n=1576), Get With The Guidelines-Stroke (n=423 809), Premier (n=91 598), and Merci Registry (n=966). Study measures were use of computed tomography scans and tissue plasminogen activator (tPA), symptomatic intracranial hemorrhage, discharge disposition, discharge National Institutes of Health Stroke Scale scores, and 90-day modified Rankin Scores.
  
  
  RESULTS
  Saint Luke's increased access to care with higher tPA use than other hospitals (17.2% received intravenous tPA therapy compared with 5.8% at Get With The Guidelines-Stroke hospitals, P<0.001; 22.1% of Saint Luke's patients received tPA by any route compared with 3.5% of Premier patients, P<0.001). Use of intravenous tPA within 4.5 hours of onset was associated with more discharges to home (odds ratio, 2.123; 95% confidence interval, 1.394-3.246) and improved National Institutes of Health Stroke Scale scores (P=0.001). Saint Luke's patients also were more likely than those in other hospitals to receive computed tomography scans (99.4% vs 58.6% at Premier hospitals). Embolectomy at Saint Luke's was associated with better outcomes than peer hospitals, and treatment at Saint Luke's was independently associated with more discharges to home (odds ratio, 3.92; 95% confidence interval, 1.84-8.32). In 2010, symptomatic intracranial hemorrhages after tPA therapy was similar for Saint Luke's patients and Premier patients (2.2% vs 1.5%; P=0.590).
  
  
  CONCLUSIONS
  Regionally coordinated stroke programs can substantially improve access and patient outcomes.
authors.affiliation: Saint Luke's Neuroscience Institute, 4401 Wornall Road, Suite 3112, Kansas City, MO 64111, USA. mrymer@saint-lukes.org
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Rymer
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
authors.forename: Gary
authors.initials: G
authors.lastname: Walker
authors.forename: Sissi
authors.initials: S
authors.lastname: Pham
authors.forename: Denise
authors.initials: D
authors.lastname: Kruzikas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019058:Community Networks / Q000592:standards*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D062606:Tertiary Care Centers / Q000592:standards*; D016896:Treatment Outcome