Abstract WMP101: Stroke Performance Measures are Improved at Hospitals Certified as Primary Stroke Centers Compared to Other Accredited Hospitals

Background: Primary Stroke Centers (PSCs) certified by The Joint Commission (TJC) have been recognized since 2003, yet doubt still exists regarding the extent they improve patient care compared to hospitals that are not certified PSCs. We compared various performance measures between such hospitals to examine this issue. Methods: Patient data from accredited hospitals that were not certified PSCs were compared to data from accredited hospitals that were TJC certified PSCs in 2009-2011. In 2009, 11 non-PSC certified accredited hospitals reported on the Stroke Core Measure set ; in 2010, this number rose to 40, and in 2011, 56 non-certified accredited hospitals reported on the Stroke Core Measures. During the same period (2009, 2010 and 2011 respectively), 38, 99, and 111 Certified Primary Stroke Centers reported on the Stroke Core Measure set as part of their accreditation requirement. Data were obtained from TJC ORYX database. At the measure level, a logistic mixed effects model was used to compare measure rates among hospitals. Results: Data were available from 284,261patients (29,207at non-PSCs and 255,054 at PSCs). The measures analyzed were VTE prophylaxis (STK1), discharge on antithrombotics (STK2), anticoagulation for A fib (STK3), use of IV t-PA (STK4), use of antithrombotics by day 2 (STK5), discharge on statins (STK6), stroke education (STK8), and consideration of rehabilitation (STK10). For all measures combined, the rate of compliance ranged from 74% vs. 91% (non-PSC vs. PSC, 2009) to 85% vs. 95% in 2011. All composite measures had higher compliance rates at certified PSCs vs. non-PSCs (p < 0.0001). Each individual measure differed significantly (p < 0.0001 for each), with STK4 having the largest difference (24% vs. 72%, non-PSC vs. PSC) and STK2 having the smallest (95% vs. 99%). Other measures showing large differences included STK8 (70% vs. 89%), STK 1 (79% vs. 93%), and STK6 (83% vs. 94%). Conclusions: PSCs certified by TJC met each stroke performance measure at a higher rate compared to non-PSC hospitals reporting stroke performance measure data. These differences narrowed somewhat over time but remained significant in 2011. Further research is warranted to examine the impact of all aspects of PSC certification on stroke patient care quality.