“Does stroke center certification improve stroke outcomes in society?” Dr. Johnston asked. “I think the answer is ‘yes.’” The greatest value of the system is that it provides a framework for regionalization, he said. “Without stroke certification, how do you convince your EMS people that they need to bypass hospitals [with poorer stroke care] in order to come to ones like UCSF? You can’t just say, ‘Look at our data’; the EMS isn’t going to be influenced by that. Getting patients to hospitals that provide better care is definitely going to improve care.”
Both presenters also emphasized that the existence of stroke centers can motivate and empower centers—many of them are already on the right track, according to Dr. Johnston—to provide better stroke care.
“Encouraging hospitals to improve their care because they’re going to be bypassed is hugely influential in their behavior,” Dr. Johnston said. “What you want to do is take hospitals that didn’t care about stroke and make them care about stroke.”
“You’ve got the large academic medical centers at the top that are doing comprehensive stroke center care without a formal certification process yet, and that’s fine,” added Dr. Alberts. “Then you’ve got some hospitals at the bottom that are very small and that are never going to be stroke centers, and that’s fine, although stroke patients should bypass those hospitals. But in the middle, you have a large number of hospitals that can go either way. And I think a formalized process of stroke center certification will help them decide, ‘Do we want to do this, or do we not want to do this?’”
—Jack Baney