Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr;55(4):1051-1058.
doi: 10.1161/STROKEAHA.123.045368. Epub 2024 Mar 12.

Heterogeneity of State Stroke Center Certification and Designation Processes

Madeline Feldmeier  1 , Anthony S Kim  2 , Kori S Zachrison  3   4 , Mark J Alberts  5 , Yu-Chu Shen  6   7 , Renee Y Hsia  1   8
Affiliations

Heterogeneity of State Stroke Center Certification and Designation Processes

Madeline Feldmeier et al. Stroke. 2024 Apr.

Abstract

Background: Stroke centers are critical for the timely diagnosis and treatment of acute stroke and have been associated with improved treatment and outcomes; however, variability exists in the definitions and processes used to certify and designate these centers. Our study categorizes state stroke center certification and designation processes and provides examples of state processes across the United States, specifically in states with independent designation processes that do not rely on national certification.

Methods: In this cross-sectional study from September 2022 to April 2023, we used peer-reviewed literature, primary source documents from states, and communication with state officials in all 50 states to capture each state's process for stroke center certification and designation. We categorized this information and outlined examples of processes in each category.

Results: Our cross-sectional study of state-level stroke center certification and designation processes across states reveals significant heterogeneity in the terminology used to describe state processes and the processes themselves. We identify 3 main categories of state processes: No State Certification or Designation Process (category A; n=12), State Designation Reliant on National Certification Only (category B; n=24), and State Has Option for Self-Certification or Independent Designation (category C; n=14). Furthermore, we describe 3 subcategories of self-certification or independent state designation processes: State Relies on Self-Certification or Independent Designation for Acute Stroke Ready Hospital or Equivalent (category C1; n=3), State Has Hybrid Model for Acute Stroke Ready Hospital or Equivalent (category C2; n=5), and State Has Hybrid Model for Primary Stroke Center and Above (category C3; n=6).

Conclusions: Our study found significant heterogeneity in state-level processes. A better understanding of how these differences may impact the rigor of each process and clinical performance of stroke centers is worthy of further investigation.

Keywords: accreditation; certification; health services research; stroke; thrombectomy.

PubMed Disclaimer

Conflict of interest statement

Disclosures Drs Shen and Hsia and M. Feldmeier report grants from the National Institute on Aging, National Institute on Minority Health and Health Disparities, and National Heart, Lung, and Blood Institute. Dr Zachrison reports grants from the National Institute on Aging, Agency for Healthcare Research and Quality, National Institute of Neurological Disorders and Stroke, CRICO, American College of Emergency Physicians, and MGH Executive Committee on Research, employment by Partners Healthcare and Boston Bruins, and compensation from Wolters Kluwer Health, Inc, for other services. Dr Kim reports grant funding from the National Institute of Neurological Disorders and Stroke, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, the American Heart Association, and Patient-Centered Outcomes Research Institute. Dr Alberts reports grant funding from the National Institute of Neurological Disorders and Stroke, Patient-Centered Outcomes Research Institute, and AstraZeneca.

Figures

Figure 1.
Figure 1.
Categorization of States with State-Level Stroke Center Certification or Designation Processes States are categorized by the presence of a state-level certification or designation process for hospitals. Many hospitals choose to pursue certification through certifying organizations outside of the state-level process; this is not represented in this figure. Categories include A. No State Certification or Designation Process; B. State Designation Reliant on National Certification Only; or C. State Has Option for Self-Certification or Independent Designation. *In addition to the four national certifying organizations, Texas also accepts certifications from Texas EMS Trauma & Acute Care Foundation for Level IV (Acute Stroke Ready) hospitals. **The Michigan Department of Health and Human Services publishes a list of hospitals participating in the Paul Coverdell National Acute Stroke Program (PCNASP) and corresponding stroke certification levels. While PCNASP is not a state designation program, state recognition of hospital stroke certification categorizes Michigan’s process as category B. Washington DC was not included in this study. Figure created with mapchart.net
See this image and copyright information in PMC

Comment in

References

    1. Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, Khalessi AA, Bushnell C, Barsan WG, Panagos P et al. Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update. Stroke. 2019;50:e187–e210. - PubMed
    1. CDC. Stroke Systems of Care: Policy Resources. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/dhdsp/policy_resources/stroke_systems_of_care/index.htm. Accessed April 5, 2023.
    1. Man S, Schold JD, Uchino K. Impact of Stroke Center Certification on Mortality After Ischemic Stroke. Stroke. 2017;48:2527–2533. - PubMed
    1. Marulanda E, Bustillo A, Gutierrez CM, Rose DZ, Jameson A, Gardener H, Alkhachroum A, Zhou L, Ying H, Dong C et al. Nationally Certified Stroke Centers Outperform Self-Attested Stroke Centers in the Florida Stroke Registry. Stroke. 2023;54:840–847. - PubMed
    1. Alberts MJ, Williams S, Hampel M, Schmaltz S, Donini-Lenhoff A, Baker D. Abstract WP72: Administration Rates for IV TPA Varies by Type of Stroke Center. Stroke. 2016;47:AWP72–AWP72.

Publication types