I heard an interesting debate at the International Stroke Conference about whether or not having a “Stroke Center” designation improves outcomes for patients with stroke. What made it even more interesting is that the debater arguing against this idea is director of a certified Stroke Center.
The Joint Commission, in collaboration with the American Heart Association and the America Stroke Association, developed certification criteria and started designating qualified medical centers as Primary Stroke Centers beginning in December 2003. The idea was to recognize centers that could provide superior care for people with acute ischemic stroke and motivate other centers to reach for this level of excellence.
Dr. Mark J. Alberts, director of the stroke program at Northwestern University, Chicago, cited lots of evidence over many years showing higher rates of using clot-busting drugs, lower death rates, and less need for institutionalization when patients were treated in stroke units compared with other hospital care. Impressive.
Most of that data, however, came from studies conducted before The Joint Commission started handing out the Stroke Center designation, noted Dr. S. Claiborne Johnston, director of the stroke service at the University of California, San Francisco. He agreed that care is better at Primary Stroke Centers, but argued that these were the centers that already were excelling at stroke care and working hard to improve stroke care, and so they applied for and earned the Primary Stroke Center labels. There’s no evidence that the label itself improved outcomes at those centers.
I suppose Dr. Johnston won the debate on a verbal technicality. But he graciously posed a different question that probably everyone could agree upon: Does society benefit from Stroke Center certifications? It sure seems so. Because of Stroke Center certification, emergency medical services teams steer ambulances toward Stroke Centers and bypass non-certified hospitals when they have a patient with stroke on board. By providing a framework for regionalization of care, the Stroke Center designation helps get patients to hospitals that provide better stroke care, improving outcomes on a society-wide level.
(Follow me on Twitter @sherryboschert)