Stroke centers ‘here to stay’
MedWire News: Joint Commission (JC) primary stroke center certification generally identifies, but does not guarantee, improved hospital performance with regard to stroke mortality, a study shows.
"Moreover, the lack of certification does not necessarily indicate poorer hospital performance," say Judith Lichtman (Yale University School of Medicine, New Haven, Connecticut, USA) and colleagues.
The team also found that JC certification had no impact on the rate of readmissions.
The research, which appears in the journal Neurology, covers 310,381 stroke patients treated at 315 JC-certified primary stroke centers and 4231 noncertified hospitals during 2006.
The 30-day mortality rates, after being standardized for patients' risk for dying, were 10.7% among patients treated at JC-certified hospitals. This was significantly lower than the 11.0% rate found among patients treated at other hospitals.
Despite the very small difference, Lichtman et al found that 48.9% of JC-certified hospitals had risk-standardized mortality rates that were significantly below the national average, compared with just 18.5% of noncertified hospitals.
Mortality rates were equivalent to the national average in 45.4% of JC-certified hospitals, compared with 66.9% of noncertified hospitals, and rates were significantly above the average in 5.7% and 14.6% of the two hospital types, respectively.
Readmission rates did not significantly vary with JC certification, at 12.5% compared with 12.4% without certification, and the researchers found no heterogeneity when comparing hospital rates with the national average.
"Additional research is needed to identify the key determinants of hospital performance, to reduce variability and improve patient outcomes," they conclude.
In an accompanying editorial, Jason Mackey and Dawn Kleindorfer (University of Cincinnati College of Medicine, Ohio, USA) asked if mortality and readmission are the best indicators of quality stroke care.
"The effect of JC certification on the burden of long-term stroke survivor morbidity, which consumes both personal and public resources, may have greater societal repercussions," they said.
However, they concluded: "The bottom line for our patients and our profession is that there seem to be modest improvements in the outcomes of patients who receive care at centers dedicated to stroke care. Stroke centers are here to stay."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid