title: Vascular Neurologists as Directors of Stroke Centers in the United States.
abstract: OBJECTIVE
  Hospital certification as primary and comprehensive stroke center is associated with improvement in care. We aimed to characterize the leadership at stroke centers nationwide to determine the proportion led by vascular neurologists, a board-recognized subspecialty focusing on stroke care.
  
  
  METHODS
  We identified hospitals in the United States holding primary and comprehensive stroke center designation as of September 2013. We contacted each hospital to identify the medical director and used data from relevant medical boards to determine specialization. Sex and date of medical school graduation were obtained from an online physician database.
  
  
  RESULTS
  Of the 1167 primary and 50 comprehensive stroke center hospitals certified by the Joint Commission (n=1114), Det Norske Veritas (n=68), and Healthcare Facilities Accreditation Program (n=35), we identified the director in 940 (77%). Leadership was most often by a neurologist (n=745; 79%) followed by physicians in emergency medicine (n=58; 6%) and internal medicine (n=17; 2%). Vascular neurologists (n=319) led about one-third of stroke centers. Directors were mostly men (n=764; 81%), with a median number of years after medical school graduation of 25 (interquartile range, 18-34). Comprehensive stroke centers were more likely than primary stroke centers to have leadership by vascular neurologist (77%, n=37 versus 32%, n=282; P<0.001).
  
  
  CONCLUSIONS
  Vascular neurologist led about one-third of stroke centers. There is opportunity for vascular neurologists to increase their role in stroke center directorship.
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Lucas
authors.initials: L
authors.lastname: Ramirez
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Aaron
authors.initials: A
authors.lastname: Krug
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Heng
authors.initials: H
authors.lastname: Nhoung
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Suzie
authors.initials: S
authors.lastname: Kazaryan
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Gregory
authors.initials: G
authors.lastname: Gasparian
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Joshua
authors.initials: J
authors.lastname: Perese
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Ali
authors.initials: A
authors.lastname: Razmara
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.).
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.affiliation: From the Keck School of Medicine (L.R., A.K., A.R., N.S.), Department of Neurology (L.R., A.R., N.S.), and Roxanna Todd Hodges Comprehensive Stroke Clinic, Department of Neurology (A.K., H.N., S.K., G.G., J.P., A.R., N.S.), University of Southern California, Los Angeles; Neurovascular Imaging Research Core, Department of Neurology, University of California Los Angeles (D.S.L.); and Stroke Center and Department of Neurology, University of Utah, Salt Lake City (J.J.M.). nsanossi@usc.edu.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
mesh_terms: D000068:Accreditation / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D005260:Female; D006782:Hospitals, Special / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D020521:Stroke / Q000628:therapy*; D014481:United States
keywords: accreditation; certification; neurology; stroke