Abstract TP394: Who Does It Better? Stroke Outcomes for Comprehensive versus Primary versus Stroke Support Facilities.

Abstract

Background: Tiered levels of stroke care have developed out of population need and have capabilities that range from centers with no specialized stroke care, to stroke care support centers (SSC), Primary Stroke Centers (PSC), and Comprehensive Stroke Centers (CSC). However, the stroke outcome advantages of Comprehensive Stroke Center care remain to be proven. This study is the first to investigate whether advanced stroke care capability translates to improved patient outcomes. Methods: 51 months of regional hospital data (n=32,740) from the Solucients ® data base was reviewed. Descriptive, univariate and multivariable techniques were used to analyze outcomes against stroke center designation on STATA 11.0 software. Results: For ischemic stroke, there were no statistically significant differences among stroke centers for mortality, complication, length of stay (LOS), and 30 day readmissions. CSCs and PSCs were 5.67 (p<0.001) and 2.15 (p<0.001) times more likely to administer thrombolytic treatment than stroke support and non designated centers. For hemorrhagic stroke, there were no statistically significant differences in complication and 30 day readmission rates among the different tiers. Hemorrhage mortality risk was higher at CSCs (OR=1.5, p= 0.037) and PSCs (OR=1.58, p= 0.016). Hemorrhagic stroke LOS was lower for all stroke center designations compared to non designated centers. CSCs and PSCs were associated with increasingly dependent discharge dispositions (coef= 0.227, p<0.001, coef=0.202, p<0.001, respectively). Conclusions: Ischemic stroke patients were more likely to receive thrombolytic treatment at Primary and Comprehensive stroke centers, but not more likely to die or experience complications or readmissions. The tertiary referral status that PSCs and CSCs serve for lower-tiered stroke treatment centers may explain the higher rate of discharge to long-term/ dependent care facilities from PSCs and CSCs.