Compliance with acute stroke care quality measures in hospitals with and without primary stroke center certification: the North Carolina Stroke Care Collaborative.

BACKGROUND: Organized stroke care is associated with improved outcomes. Data are limited on differences in changes in the quality of acute stroke care at The Joint Commission-certified Primary Stroke Centers (PSCs) versus non-PSCs over time. METHODS AND RESULTS: We compared compliance with the Joint Commission's 10 acute stroke care performance measures and defect-free care in PSCs and non-PSCs participating in the Registry of the North Carolina Stroke Care Collaborative from January 2005 through February 2010. We included 29 654 cases presenting at 47 hospitals-10 PSCs, 8 preparing for certification, and 29 non-PSCs-representing 43% of North Carolina's non-Veterans Affairs, acute care hospitals. Using a non-PSC referent, odds ratios and 95% CIs were calculated using logistic regression and generalized estimating equations accounting for clustering of cases within hospitals. Time trends were presented graphically using simple linear regression. Performance measure compliance increased for all measures for all 3 groups in 2005-2010, with the exception of discharge on antithrombotics, which remained consistently high. PSCs and hospitals preparing for certification had better compliance with all but 2 performance measures compared with non-PSCs (each P<0.01). Defect-free care was delivered most consistently at hospitals preparing for certification (52.8%), followed by PSCs (45.0%) and non-PSCs (21.9%). Between 2005 and 2010, PSCs and hospitals preparing for certification had a higher average annual percent increase in the provision of defect-free care (P=0.01 and 0.04, respectively) compared with non-PSCs. CONCLUSIONS: PSC certification is associated with an overall improvement in the quality of stroke care in North Carolina; however, room for improvement remains.

Duke Scholars

Author Larry Bruce Goldstein Neurology, Stroke and Vascular Neurology

Author Emily O'Brien Population Health Sciences