Abstract 125: Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality Among Hemorrhagic Stroke Patients in New York, 2008-2012

Abstract

Background: While designated stroke centers (DSC) improve quality of care and outcomes for ischemic stroke patients, less is known regarding the benefits of DSCs for patients with intracerebral (ICH) and subarachnoid hemorrhage (SAH). Hypothesis: Compared to non-DSCs, hospitals with DSC status will have lower in-hospital mortality for hemorrhagic stroke patients independently of other hospital-level characteristics, including hospital size, urban location, and teaching status. Methods: We evaluated ICH (ICD-9 431) and SAH (ICD-9 430) hospitalizations that were recorded in the 2008-2012 New York State Department of Health’s Statewide Planning and Research Cooperative System (SPARCS) inpatient sample database. The relationship between DSC status and in-hospital mortality was evaluated using generalized estimating equation logistic regression to calculate OR’s and 95% confidence intervals; analyses were adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. In secondary analyses we explored if other hospital characteristics were associated with in-hospital mortality. Results: Of 6501 ICH and 3440 SAH patients, in-hospital mortality was higher among those with ICH compared to SAH (23.7% vs. 18.5%). Unadjusted analyses revealed DSC was related with reduced mortality for both ICH (OR: 0.7; 0.6-0.8) and SAH patients (OR: 0.4; 0.3-0.7). DSC remained a significant predictor of in-hospital mortality for SAH patients (OR: 0.6; 0.4-0.9) but not for ICH patients (OR: 0.9; 0.6-1.2) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Conclusions: Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those suffering from ICH. Other patient and hospital characteristics may explain the apparent benefit of PSC status on outcomes after ICH. Addressing gaps in stroke care through assessment of hospital-level factors indicates a potential target for quality of care improvement.