Abstract 155: Treatment Outcomes After Regionalization of Acute Stroke Care

Abstract

Objective: To determine if regionalization of stroke care is associated with improved treatment rates. Methods: This is an observational study of all patients with a discharge diagnosis of stroke admitted to hospitals located in a Northern California county during a three year period. Patient and hospital demographic data, stroke center designation status, teaching status of the hospital, hospital discharge diagnosis and treatment with intravenous thrombolysis (IV t-PA) for the pre and post phase of regionalization were obtained from the statewide discharge database. We included patients ≥18 years of age with validated ICD- 9 code for stroke and excluded inter-facility transports and direct admissions. Logistic regression was performed to study the independent association of regionalization with IV t-PA treatment rates. Data analysis was performed using SAS 9.2 Results: Number of patients with a discharge diagnosis of stroke in the pre-regionalization phase was 2149 and in the post regionalization phase was 4261. In the regionalized phase, mean age at time of admission was 73 (+/-15) years; 54% of patients (n=2280) were females and 62% (n=2649) of the patients were whites. Majority of patients were transported from home (3647, 86%); 2847 (67%) were treated at stroke centers and 4133 (97%) were treated at community hospitals. After controlling for patient and hospital demographics, teaching status and stroke center status, regionalization was not associated with increase in IV t-PA use (OR 0.8, p <0.001) Conclusions: While county-wide treatment rates for stroke did not improve after regionalization of care, similar relationship in those transported by emergency medical services in a regionalized system should be explored.