The Uncoordinated U.S. Primary Stroke Centers

From the International Stroke Conference in San Antonio

The good news for U.S. stroke patients is that in March 2010, 685 certified primary stroke centers existed in America. The bad news is that no one makes sure they’re optimally placed to maximize coverage of the U.S. population.

The Joint Commission, a U.S. hospital accreditation organization, began certifying primary stroke centers in December 2003. The idea was that these centers would specialize in state-of-the-art stroke care and become the prime locations for acute stroke patients to receive care.

The concept has certainly taken root. According to Dr. Karen C. Albright, a neurologist at the University of California, San Diego, 524 certified American primary stroke centers existed by November 2008, and another 102 came on board during the following year, through late September, 2009. The pace for new center certifications has held steady, with another 59 centers added to the list during a little more than another 5 months.

Stroke patients who live in the white areas have a greater than 60 minute trip to their nearest primary stroke center (photo by Mitchel Zoler).

But according to Dr. Albright, many of the new centers added during Nov. 2008-Sept. 2009 were “in proximity to existing centers.” No person or group controls where new stroke centers open, and they’ve left big gaps of uncovered population. Based on the centers that existed last September, Dr. Albright estimated that roughly 63 million to 135 million Americans lived more than 60 minutes away from the closest primary stroke center (see map). The upper end number, 135 million, applied if all emergency stroke transport was by ambulance. The number fell to 63 million if all centers had helicopter transport available, but that’s a big if because in reality many centers don’t use air transport.

Some excellent models exist for better emergency-care coordination, most notably the way trauma care is integrated and delivered across the U.S., particularly by regional systems like the Southeast Texas Trauma Regional Advisory Council.  Recently, SETTRAC set up regional coordination of emergency stroke care in the Houston area.

Now all that has to happen is for this approach to spread through the rest of Texas, and then the rest of the United States.

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Cardiovascular Medicine, Emergency Medicine, Family Medicine, Health Policy, IMNG, Internal Medicine, Neurology and Neurological Surgery, Practice Trends

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