SEATTLE—Being a certified primary stroke center is associated with high rates of IV t-PA administration to eligible patients, according to findings presented by Mark J. Alberts, MD, at the 61st Annual Meeting of the American Academy of Neurology.
“Use of IV t-PA to treat eligible patients with acute stroke is an important aspect of care at a primary stroke center, but it’s certainly not the only reason to come to a primary stroke center,” said Dr. Alberts, Professor of Neurology at Feinberg School of Medicine, Northwestern University, Chicago. “IV t-PA remains one of the few FDA-approved treatments for acute ischemic stroke, and IV t-PA is included in all acute stroke care guidelines…. So it’s important to track the use of IV t-PA at stroke centers.”
To assess t-PA use rates in correlation with the number of Joint Commission certification cycles and type of facility, the researchers obtained data from the American Hospital Association Healthcare QuickDisc database and from Joint Commission files. “t-PA administration was defined as patient presentation within 120 minutes of time [that he or she was] last known normal and IV t-PA administered within 180 minutes of when the patient was last known normal,” Dr. Alberts explained.
“Since January 2008, 418 primary stroke centers have reported t-PA utilization rates,” noted Dr. Alberts and colleagues. Of these, 200 were certified within the last two years; 197 were in their second certification cycle, and 21 were in their third certification cycle. Two hundred fifty-one primary stroke centers were teaching hospitals, and 154 were nonteaching hospitals.
Of 2,469 eligible patients, 1,902 received IV t-PA for an overall utilization rate of 77%. IV t-PA administration rates were 73% for primary stroke centers in the first cycle of certification, 78% for hospitals in their second cycle, and 94% for hospitals in their third cycle.
Among hospitals in their first certification cycle, there was a 70% rate of IV t-PA use at nonteaching hospitals, compared with 81% at teaching hospitals. However, “the differences between t-PA administration rates at teaching and nonteaching hospitals diminished as the number of certification cycles increased,” stated Dr. Alberts and colleagues.
“The high rates of t-PA use in teaching hospitals could be due to a number of factors, including availability of stroke teams 24/7, being very familiar with the t-PA protocol, improved guidance from fellows and attendings in terms of how to give it, and better patient education in terms of understanding the benefits of t-PA therapy,” Dr. Alberts commented.
“The increased use of t-PA with increased recertifications sort of makes sense, because you have more experience among the medical staff, more efficient care leading to fewer treatment delays, … and improved marketing of the stroke center and its programs,” he added.
“These data further support the importance of primary stroke centers and how time and experience improve some aspects of acute stroke care,” concluded Dr. Alberts.
—Karen L. Spittler