Hospital and demographic characteristics associated with advanced primary stroke center designation.
OBJECTIVE
Despite evidence that primary stroke center (PSC) certification is associated with improvements in care and outcome, only a minority of hospitals have achieved this certification. We sought to determine hospital-based factors associated with achievement of PSC certification.


METHODS
We used the 2011 American Hospital Association survey and the 2010 national census for population and household data to identify potential hospital and demographic factors influencing certification as a PSC by the Joint Commission, Healthcare Facilities Accreditation Program, and DNV Healthcare.


RESULTS
Of the 3696 hospitals to complete the survey, 3069 fulfilling study criteria included 908 PSC (31%) and 2161 non-PSC. Independent hospital characteristics associated with PSC certification were Joint Commission accreditation (odds ratio [OR], 3.5; 95% confidence interval [CI], 2.4-5.0), increasing size (per quartile in number of beds; OR, 2.5; 95% CI, 2.1-3.1) and inpatient neurological services (OR, 3.2; 95% CI, 2.4-4.6), number of households per zip code (per 1000 households; OR, 1.1; 95% CI, 1.0-1.2), increasing Hispanic population (by 10% increase; OR, 1.1; 95% CI, 1.0-1.2), and income per household (per $10 000; OR, 1.2; 95% CI, 1.1-1.3). Designation as a sole community provider (OR, 0.22; 0.10-0.47) or governmental hospital control (0.61; 0.44-0.84) was associated with noncertification.


CONCLUSIONS
Less than 1 in 3 hospitals has achieved certification as an PSC. Potential areas of improvement include increasing certification of governmental-controlled hospitals.
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
Catherine M
CM
McDonald
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
Steven
S
Cen
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
Lucas
L
Ramirez
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
Sarah
S
Song
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
Jeffrey L
JL
Saver
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.).
William J
WJ
Mack
From the Keck School of Medicine (C.M.M., S.C., L.R., W.J.M., N.S.), Departments of Neurology (S.C., L.R., N.S.) and Neurosurgery (W.J.M.), and Roxanna Todd Hodges Comprehensive Stroke Clinic (S.C., W.J.M., N.S.), University of Southern California, Los Angeles; Department of Neurology, Rush University, Chicago, IL (S.S.); and UCLA Stroke Center (J.L.S.). nsanossi@usc.edu.
Nerses
N
Sanossian
D002568:Certification / Q000592:standards*; D003625:Data Collection; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D014481:United States
certification; hospitals; quality improvement