Mapping Primary and Comprehensive Stroke Centers by Certification Organization.

n 2000, members of the Brain Attack Coalition published recommendations for the establishment of primary stroke centers (PSCs), 1 and in 2005 they published recommendations for the establishment of comprehensive stroke centers (CSCs). 2 To improve patient care and outcomes for stroke, the recommendations suggested that stroke centers should include acute stroke teams, written care protocols, emergency medical services integrated with the stroke center, rapid testing procedures , and continuous improvement processes. Since then, several certification programs have been developed to identify hospitals that have established a stroke center that meets specific criteria for the treatment of stroke. The Joint Commission, DNV GL, and Healthcare Facilities Accreditation Program offer certification programs for PSCs and CSCs. PSC certification was designed to meet the Brain Attack Coalition's recommendations for improved stroke care through access to dedicated, specialized personnel and procedures. CSCs must meet all of the requirements for certification as a PSC, plus additional requirements meant to help manage complex stroke cases. These include the requirements to meet specified volumes of patients and procedures, be capable of providing advanced imaging on-site at all times, provide after hospital care coordination for patients, have dedicated neurological intensive care unit beds for complex stroke cases, participate in stroke research, and collect standard performance measures. 3 Several studies have analyzed the effectiveness of stroke centers in the care and management of patients with stroke. In New York state, patients with ischemic stroke admitted to a designated stroke center experienced a lower 30-day all-cause mortality rate and greater use of thrombolytic therapy. 4 Also, among Medicare beneficiaries aged ≥65 years, hemorrhagic stroke patients treated at Joint Commission certified PSCs had lower 30-day mortality rates. 5 PSCs and CSCs have shown improvements in stroke performance measures, the collection of which is required to maintain certification. 3 The maps displayed here show the locations of Primary and Comprehensive Stroke Centers certified by The Joint Commission, DNV GL, and Healthcare Facilities Accreditation Program as of May 2015 overlaid on stroke hospitalization rates and discharge status by county among Medicare fee-for-service beneficiaries aged ≥65 in the United States (2010–2012). Rates are age standardized and spatially smoothed to enhance the stability of rates in counties with small populations. Counties with the highest stroke hospitalization rates (13.5–24.1 per 1000 total beneficiaries) were located primarily in the Southeast for both total beneficiaries and black beneficiaries (Figure 1). CSCs (n=113) are located in 32 states …