title: Rates of Adverse Events and Outcomes among Stroke Patients Admitted to Primary Stroke Centers.
abstract: OBJECTIVE
  To identify the beneficial effects of primary stroke centers (PSCs) certification by Joint Commission (JC), we compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States.
  
  
  METHODS
  We obtained the data from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the Nationwide Inpatient Sample hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease, 9th Revision, codes 433.x1, 434.x1).
  
  
  RESULTS
  We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted to PSCs. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to PSCs were at lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR], .8; 95% confidence interval [CI], .7-.8) and sepsis (OR, .7; 95% CI, .6-.8). Patients admitted to PSCs were more likely to receive thrombolysis (OR, 1.6; 95% CI, 1.5-1.7). The mean cost of hospitalization (95% CI) of the patients was significantly higher in patients admitted at PSCs compared with those admitted at non PSC hospitals $47621 (47099-48144) vs. $35229 (34803-35654), P < .0001). The patients admitted to PSCs had lower inpatient mortality (OR, .8; 95% CI, .8-.9) and were more likely to be discharged with none to minimal disability (OR, 1.1; 95% CI, 1.0-1.1).
  
  
  CONCLUSIONS
  Compared with non-PSC admissions, patients admitted to PSCs are less likely to experience hospital adverse events and more likely to experience better discharge outcomes.
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan. Electronic address: chaudhrys208@gmail.com.
authors.forename: Saqib A
authors.initials: SA
authors.lastname: Chaudhry
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Afzal
authors.affiliation: Department of Neurology, Cleveland Clinic, Lakewood, Ohio.
authors.forename: Burhan Z
authors.initials: BZ
authors.lastname: Chaudhry
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
authors.forename: Taqi T
authors.initials: TT
authors.lastname: Zafar
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan.
authors.forename: Adnan
authors.initials: A
authors.lastname: Safdar
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan.
authors.forename: Mounzer Y
authors.initials: MY
authors.lastname: Kassab
authors.affiliation: Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan.
authors.forename: Syed I
authors.initials: SI
authors.lastname: Hussain
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000379:methods* / Q000592:standards; D006801:Humans; D007297:Inpatients; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D010351:Patient Discharge; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: Ischemic stroke; certified stroke center; in-hospital adverse events; outcomes; primary stroke centers; thrombolysis