title: Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization.
abstract: Primary stroke center (PSC) certification was established to identify hospitals providing evidence-based care for stroke patients. The numbers of PSCs certified by Joint Commission (JC), Healthcare Facilities Accreditation Program, Det Norske Veritas, and State-based agencies have significantly increased in the past decade. This study aimed to evaluate whether PSCs certified by different organizations have similar quality of care and in-hospital outcomes.
  
  
  
  The study population consisted of acute ischemic stroke patients who were admitted to PSCs participating in Get With The Guidelines-Stroke between January 1, 2010, and December 31, 2012. Measures of care quality and outcomes were compared among the 4 different PSC certifications.
  
  
  
  A total of 477 297 acute ischemic stroke admissions were identified from 977 certified PSCs (73.8% JC, 3.7% Det Norske Veritas, 1.2% Healthcare Facilities Accreditation Program, and 21.3% State-based). Composite care quality was generally similar among the 4 groups of hospitals, although State-based PSCs underperformed JC PSCs in a few key measures, including intravenous tissue-type plasminogen activator use. The rates of tissue-type plasminogen activator use were higher in JC and Det Norske Veritas (9.0% and 9.8%) and lower in State and Healthcare Facilities Accreditation Program certified hospitals (7.1% and 5.9%) (P<0.0001). Door-to-needle times were significantly longer in Healthcare Facilities Accreditation Program hospitals. State PSCs had higher in-hospital risk-adjusted mortality (odds ratio 1.23, 95% confidence intervals 1.07-1.41) compared with JC PSCs.
  
  
  
  Among Get With The Guidelines-Stroke hospitals with PSC certification, acute ischemic stroke quality of care and outcomes may differ according to which organization provided certification. These findings may have important implications for further improving systems of care.
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Shumei
authors.initials: S
authors.lastname: Man
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Puja
authors.initials: P
authors.lastname: Patel
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.). gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002568:Certification / Q000592:standards*; D005260:Female; D006783:Hospitals, State / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: certification; ischemic stroke; outcome; primary stroke center; quality of care