Abstract
Background:
The beneficial impact of certification by Joint Commission (JC) for primary stroke centers (PSCs), on in hospital adverse events and outcomes remains unproven.
Objective:
To compare the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients between PSC and no PSC hospitals in United States.
Methods and Results:
We obtained the data from Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the NIS 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 (ICD9 codes 433.x1, 434.x1, 436).
Results:
We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted at PSCs. Patients admitted at PSCs were more likely to be men (48.3 vs. 46.7, p<0.0001), white (75.2 vs. 73.3, p<0.0001) and younger in age (71.1±14.7 vs. 72.3±14.3 p<0.0001. Total length of stay was similar among PSCs and non-PSCs (5.09±6. vs. 5.14±6.15 p<0.0001), while total charges were higher at PSCs ($48828 vs. $35946±14.3 p<0.0001). After adjusting for age, sex, race co-morbidities, DRG-based disease severity, and hospital characteristics, patients admitted at PSCs were at lower risk of in hospital adverse events complications; pneumonia (OR, 0.8; 95% CI, 0.7 to 0.9)-, urinary tract infection (OR, 0.97; 95% CI, 0.0.92 to 1.02), sepsis (OR, 0.65; 95% CI, 0..56 to 0..76), deep venous thrombosis (OR, 1.0; 95% CI, 0.76 to 1.33) and pulmonary embolism (OR, 0.58; 95% CI, 0.43 to 0.72). Patients evaluated at PSCs were more likely to receive rt-PA (OR, 1.32; 95% CI, 1.19 to 1.45) with less impatient mortality (OR, 0.88; 95% CI, 0.81 to 0.96) and more likely to get discharge to home (OR, 1.11; 95% CI, 1.07 to 1.15).
Conclusions:
Patients admitted to PSCs are less likely to have in hospital adverse events and better discharge outcomes.