Abstract 3442: A Regional Assessment of Mismatch between Joint Commission Certified Stroke Centers and Population Requirements

Abstract

Background: The Joint Commission identifies high performing stroke centers through their certification program. Since the certification program does not incorporate a population based needs assessment, we hypothesized that some population centers may not contain certified centers. Furthermore, we hypothesized that inter-competitive behaviors of centers may be lead to clustering of certified centers. Methods: We identified all the primary stroke centers (PSCs) that were certified by Joint Commission through a directory maintained by the organization. We identified the addresses of all the certified stroke centers in the upper Midwest (ND, SD, MN, IA, WI) and determined the latitude and longitude coordinates for these locations. We then obtained a list of all the census blocks in the upper Midwest that included the populations and latitude and longitude coordinates for each census block. We used the Haversine formula to calculate the great circle distance between each stroke center and each census block and then identified the five stroke centers closest to each census block. From this we were able to identify the census blocks within 15 miles of multiple stroke centers in the upper Midwest. We also identified every census block within 15 miles of each stroke center. From this we calculated the total population within 15 miles of each stroke center. Results: We identified a total of 56 PSC hospitals that are serving a population of 15.4 million in 2010 in upper Midwest. Of the population served, 53% of the population lives within 15 miles of a PSC. Of these, 3%, 6%, and 1% live within 15 miles of 2,3, and 4 PSCs; 21% live within 15 miles of 5 or more PSCs. Seven PSCs have a population of ≤100,000 per PSC within 15 miles, and 49 PSCs have a population of >100,000 per PSC within 15 miles; 18 PSCs have a population of 1 million or greater within 15 miles. Conclusions: We found that almost half of the population in the Midwest does not reside within 15 miles of a PSC while one-fifth of the population resides within 15 miles of 5 or more PSCs. Such mismatches highlight the need for PSC designation to consider population needs to ensure homogeneity of care.