Outcomes after ischemic stroke for hospitals with and without Joint Commission―certified primary stroke centers

• Published in: Neurology Vol. 76; no. 23; pp. 1976 - 1982
• Main Authors: LICHTMAN, J. H, JONES, S. B, WANG, Y, WATANABE, E, LEIFHEIT-LIMSON, E, GOLDSTEIN, L. B
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 07-06-2011
• Subjects: Aged; Biological and medical sciences; Brain Ischemia - mortality; Brain Ischemia - therapy; Certification - standards; Certification - trends; Cohort Studies; Female; Hospitals - classification; Hospitals - standards; Hospitals - trends; Humans; Intensive Care Units - standards; Intensive Care Units - trends; Joint Commission on Accreditation of Healthcare Organizations - legislation & jurisprudence; Male; Medical sciences; Neurology; Quality of Health Care - standards; Quality of Health Care - trends; Stroke - mortality; Stroke - therapy; Treatment Outcome; United States - epidemiology; Vascular diseases and vascular malformations of the nervous system; United States; Cerebral infarction; Stroke; Nervous system diseases; Prognosis; Cardiovascular disease; Joint; Cerebral disorder; Vascular disease; Osteoarticular system; Central nervous system disease; Brain ischemia; Hospital; Cerebrovascular disease
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e31821e54f3

The Joint Commission (JC) began certifying primary stroke centers (PSCs) in the United States in 2003. We assessed whether 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates differed between hospitals with and without JC-certified PSCs in 2006.
The study cohort included all fee-for-service Medicare beneficiaries ≥65 years old discharged with a primary diagnosis of ischemic stroke (International Classification of Diseases, ninth revision, Clinical Modification 433, 434, 436) in 2006. Hierarchical linear regression models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, comorbid conditions, and hospital referral region. Hospitals were categorized as being higher than, no different from, or lower than the national average.
There were 310,381 ischemic stroke discharges from 315 JC-certified PSC and 4,231 noncertified hospitals. Mean overall 30-day RSMR and RSRR were 10.9% ± 1.7% and 12.5% ± 1.4%, respectively. The RSMRs of hospitals with JC-certified PSCs were lower than in noncertified hospitals (10.7% ± 1.7% vs 11.0% ± 1.7%), but the RSRRs were comparable (12.5% ± 1.3% vs 12.4% ± 1.7%). Almost half of JC-certified PSC hospitals had RSMRs lower than the national average compared with 19% of noncertified hospitals, but 13% of JC-certified PSC hospitals had lower RSRRs vs 15% of noncertified hospitals.
Hospitals with JC-certified PSCs had lower RSMRs compared with noncertified hospitals in 2006; however, differences were small. Readmission rates were similar between the 2 groups. PSC certification generally identified better-performing hospitals for mortality outcomes, but some hospitals with certified PSCs may have high RSMRs and RSRRs whereas some hospitals without PSCs have low rates. Unmeasured factors may contribute to this heterogeneity.