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State legislation aimed at increasing the number of designated primary stroke centers (PSC) appears to have had a big impact on access to stroke care in the U.S., findings from an analysis of PSC trends suggested.

Just over 1,500 acute care hospitals -- about a third of hospitals nationwide -- had been certified as primary stroke centers by the end of 2013, and the study found that states with laws designed to facilitate the implementation and use of PCS had a higher percentage of the centers than states without such laws.

Legislative action often included directives for first responder emergency medical services (EMS) personnel to bypass the nearest hospital when transporting stroke patients if there is a designated stroke center nearby, researcher , of the Cleveland Clinic, Cleveland, Ohio, and colleagues wrote in the journal published online June 18.

"Our study showed that state efforts to designate stroke centers and transport patients to those centers has had an impact," Uchino told 麻豆传媒. "And other research has shown that designated stroke centers positively impact patient care and outcomes."

Eighteen states had stroke center legislation by the end of 2013. The researchers speculated that if similar legislation were passed in all other states, more than 1,850 additional hospitals would be designated primary stroke centers.

States with Stroke Laws Saw 16% Increase in PSCs

In addition to state legislation, larger hospital size, urban location, and a greater state economic output were all associated with larger increases in PSC designations from 2009 through 2013.

During this period, the increase in PSCs was 16% among states with stroke center legislation and 6% among states without stroke legislation.

The Joint Commission and the American Heart Association/American Stroke Association began certifying hospitals as PSCs in 2003, and three out of four (74%) hospitals with the designation have been certified by The Joint Commission and AHA/ASA. The remaining PSCs have been designated by state organizations or other organizations, the researchers wrote.

"As of December 2013 there were 1,505 certified PSCs in 1,574 sites in the United States, representing 32% of 4,640 short-term adult general hospitals with emergency departments," the researchers wrote.

Among the other findings:

• The number of PSC-certified hospitals varied widely from state to state, ranging from 4% in Wyoming to 100% in Delaware. The overall state median was 25%.
• States in the Northeastern U.S. had the highest proportions of PSC-designated hospitals with 59%, followed by the West (32%), South (30%), and Midwest (24%).
• 18 states with stroke center legislation had higher PSC percentages (median 43%; range 13% to 100%) than states without such legislation (median 13%; range 4% to 75%; P<0.001).
• Larger hospitals were more likely to be PSC-certified than smaller ones. The median size of the PSC hospitals was 276 beds (interquartile range 176-411) and 13,945 annual admissions (IQR 8,544-20,887).
• Multivariable logistic regression analysis showed that hospital bed number, urban setting, state gross domestic product, and state stroke legislation were all independently associated with stroke center designation.

Delaware, Massachusetts Have Most Stroke Centers

States with some of the highest percentage of acute care hospitals with designated stroke centers were Delaware (100%), Massachusetts (97%), New Jersey (96%), and Rhode Island (90%).

States with the lowest -- between 9% and 10% of acute hospitals designated PSCs -- included West Virginia, Alabama, Mississippi, Louisiana, Arkansas, Montana, Idaho, South Dakota, Kansas, Wyoming, and Vermont.

"Our findings are consistent with the known geographic variation in utilization of intravenous thrombolysis and stroke fatality rates across the United States," the researchers wrote. "It is notable that in the Northeast region, Massachusetts, a small and relatively densely populated state in which 97% of hospitals were PSCs, lies next to New Hampshire and Vermont, states in which only 12% and 7% of hospitals were PSCs."

Uchino told 麻豆传媒 that in addition to state legislation, telemedicine and other technological advances may help smaller, poorer and more rural hospitals meet PSC guidelines in the near future.

From the American Heart Association:

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