Do lengthy travel times to Primary Stroke Centers offset benefits of specialized care?
Physicians and families of stroke victims often have to make quick decisions about whether to treat patients locally or refer them to a more distant Primary Stroke Center (PSC). Until now, there has been little information to help guide them. However, a new study by researchers from The Dartmouth Institute for Health Policy & Clinical Practice found that receiving treatment in PSCs led to significantly better survival rates for patients traveling less than 90 minutes to get there. However, traveling at least 90 minutes offset any benefit of receiving care at these centers of excellence.
The study, funded by the National Institute on Aging and the NIH Commons Fund, used a study cohort of Medicare beneficiaries with acute stroke admitted to a hospital between 2010 and 2013. During the study period, 865,184 Medicare beneficiaries— 55% of whom were female with a mean age of 78.9 years—were treated for stroke. After adjusting for differences in stroke severity, the authors found that 7-day case-fatality rates were an average of 13% lower at the 976 PSCs across the United State. The researchers also found significant regional variation in access to PSCs, with the highest number of PSCs clustered in the Northeast, the Florida coasts, and the Chicago, Los Angeles and San Francisco Bay areas. Indeed, for one-quarter of elderly stroke victims, the PSC was the closest hospital to their residence. However, 16% of stroke patients lived more than a 90-minute drive from a PSC.
Primary Stroke Centers (PSCs) are certified by The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States.
“We hope that these findings will lead to better outcomes for stroke patients and improve access to Primary Stroke Centers” says lead author Kimon Bekelis, MD. “More hospitals with PSC certification and greater reliance on helicopters are two potential approaches to improving access,” he added.
Study published onliine at JAMA IM: http://archinte.jamanetwork.com/article.aspx?articleid=2536190