Abstract WP276: Trends in Acute Stroke Treatment Among Rural Hospitals in Minnesota: Utility of Acute Stroke Ready Hospital Designation

Abstract

Background: The Minnesota Stroke System was launched in 2013 to organize and recognize hospitals able to deliver acute stroke treatment. The goal of the system is to increase access to acute stroke treatment and improve outcomes for stroke patients. The Minnesota Department of Health designates Acute Stroke Ready Hospitals (ASRHs) according to ten criteria corresponding to the 2013 Brain Attack Coalition recommendations. This analysis explores whether implementation of the Minnesota Stroke System and the corresponding adoption of standards by ASRHs corresponded to an increase in intravenous (IV) alteplase utilization among rural Minnesota hospitals between 2012 and 2017. Methods: Stroke patient care data were submitted by hospitals into the Minnesota Stroke Registry. Rural Minnesota hospitals were grouped into three categories: early adopters that became designated between 2014-2015; late adopters (designated between 2016-2017); and never-designated hospitals. Trends in IV alteplase use from 2012 to 2017 were examined in each group. Results: Among 103 rural Minnesota hospitals, 21 never received designation, 21 were designated in 2016-2017, and 61 were designated between 2014-2015. Treatment of stroke patients with IV alteplase among all rural hospitals increased in Minnesota between 2012 and 2017 from 12.9% to 15.9% (p<0.01). Among never-designated hospitals, IV alteplase use increased from 12.5% to 15.4% (p=0.13), and among late-adopting ASRHs use increased from 10.1% to 12.7% (p=0.22). In contrast, IV alteplase use significantly increased among early adopting ASRHs from 14.6% to 20.5% (p<0.0001). A significant trend was noted with IV alteplase use within the ≤3-hour window in the early adopting group (p<0.0001) and the late adopting group (p=0.02), but the trend was not significant in the never-designated group (p=0.09). Conclusions: Trends in treatment with IV alteplase was highest among early adopting ASRHs. Sustained increases in treatment rates among early adopters suggests that similar increases may be seen in late-adopting ASRHs in the future. This analysis suggests that the implementation of a statewide system of care, namely adoption of standards and hospital designation, is a driver for sustained increases in treatment rates.