Hospital and demographic characteristics associated with advanced primary stroke center designation

Abstract

Background and purpose: Despite evidence that primary stroke center (PSC) certification is associated with improvements in care and outcome, only a minority of hospitals have achieved this certification. We sought to determine hospital-based factors associated with achievement of PSC certification.

Methods: We used the 2011 American Hospital Association survey and the 2010 national census for population and household data to identify potential hospital and demographic factors influencing certification as a PSC by the Joint Commission, Healthcare Facilities Accreditation Program, and DNV Healthcare.

Results: Of the 3696 hospitals to complete the survey, 3069 fulfilling study criteria included 908 PSC (31%) and 2161 non-PSC. Independent hospital characteristics associated with PSC certification were Joint Commission accreditation (odds ratio [OR], 3.5; 95% confidence interval [CI], 2.4-5.0), increasing size (per quartile in number of beds; OR, 2.5; 95% CI, 2.1-3.1) and inpatient neurological services (OR, 3.2; 95% CI, 2.4-4.6), number of households per zip code (per 1000 households; OR, 1.1; 95% CI, 1.0-1.2), increasing Hispanic population (by 10% increase; OR, 1.1; 95% CI, 1.0-1.2), and income per household (per $10 000; OR, 1.2; 95% CI, 1.1-1.3). Designation as a sole community provider (OR, 0.22; 0.10-0.47) or governmental hospital control (0.61; 0.44-0.84) was associated with noncertification.

Conclusions: Less than 1 in 3 hospitals has achieved certification as an PSC. Potential areas of improvement include increasing certification of governmental-controlled hospitals.

Keywords: certification; hospitals; quality improvement.