The Impact of Comprehensive Stroke Care Capacity on the Hospital Volume of Stroke Interventions: A Nationwide Study in Japan: J-ASPECT Study

doi:10.1016/j.jstrokecerebrovasdis.2013.08.016

Journal of Stroke and Cerebrovascular Diseases

Volume 23, Issue 5, May–June 2014, Pages 1001-1018

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https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.08.016 Get rights and content

Background

The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions.

Methods

A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009.

Results

Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001).

Conclusion

We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.

Introduction

Stroke is the third leading cause of death worldwide and a leading cause of long-term disability. In 2000, the Brain Attack Coalition discussed the concept of stroke centers and proposed 2 types of centers: primary¹ and comprehensive.² Most stroke patients can be treated appropriately at primary stroke centers (PSCs), and the Joint Commission has established programs for the certification of, and measurement of performance in, PSCs. The concept of a comprehensive stroke center (CSC) enables intensive care and the use of specialized techniques, which are not available at most PSCs.² A set of metrics and associated data elements that cover the major types of care that distinguish CSCs from PSCs have been published recently.³ At present, when the certification of CSCs has been initiated worldwide, there are no nationwide reports on the associations between primary and comprehensive stroke care capacity and impact of comprehensive stroke care capacity on hospital volume of stroke interventions.

Section snippets

Aims

We performed a nationwide survey in Japan to determine the association between primary and comprehensive stroke care capacity and the impact of comprehensive stroke care capacity on the annual hospital volume of tissue plasminogen activator (t-PA) infusion, removal of intracerebral hemorrhage (ICH), and coiling and clipping of intracranial aneurysms (IAs).

Eligible Hospitals

The J-ASPECT study (Nationwide survey of Acute Stroke care capacity for Proper dEsignation of Comprehensive stroke cenTer in Japan) group developed a 49-question survey regarding hospital characteristics (eg, bed number, academic status, geographic location, and participation in the diagnosis procedure combination [DPC] payment system), primary and comprehensive stroke care capacity, and hospital volume of stroke interventions. The questionnaire was mailed on February 2011 to the 1369 certified

Response Rate and Responding-Hospital Characteristics

In total, 55% (749 hospitals) of the eligible institutions completed the questionnaire. The characteristics of the responding hospitals are shown in Table 1. DPC hospitals represented 65.3% of the eligible hospitals and 73.8% and 55% of the responding and nonresponding hospitals, respectively (P < .0001). The response rate of the DPC hospitals was significantly higher than that of the remaining hospitals (61.9% versus 41.3%, P < .0001). Among the DPC hospitals, a greater proportion of

Discussion

This study demonstrated a significant impact of comprehensive stroke care capacity represented by the total CSC score on the hospital volume of stroke interventions and unique aspects of comprehensive stroke care capacity in Japan.

Conclusion

The present study demonstrated a significant impact of comprehensive stroke care capacity, as represented by the total CSC score on the hospital volume of stroke interventions and unique aspects of comprehensive stroke care capacity in Japan.

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: Conflict of interest: None declared.

: This study was supported by Grants-in-Aid from the Ministry of Health, Labor, and Welfare of Japan (principal investigator: KI).

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Original ArticleThe Impact of Comprehensive Stroke Care Capacity on the Hospital Volume of Stroke Interventions: A Nationwide Study in Japan: J-ASPECT Study

Background

Methods

Results

Conclusion

Introduction

Section snippets

Aims

Eligible Hospitals

Response Rate and Responding-Hospital Characteristics

Discussion

Conclusion

J Orthop Sci

Recommendations for the establishment of primary stroke centers. Brain Attack Coalition

JAMA

Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition

Stroke

Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association

Stroke

Risk factors affecting in-hospital mortality after hip fracture: retrospective analysis using the Japanese Diagnosis Procedure Combination Database

BMJ Open

Urban employment areas: defining Japanese metropolitan areas and constructing the statistical database for them

Acute stroke care in Illinois: a statewide assessment of diagnostic and treatment capabilities

Stroke

Striking rural-urban disparities observed in acute stroke care capacity and services in the pacific northwest: implications and recommendations

Stroke

Original Article
The Impact of Comprehensive Stroke Care Capacity on the Hospital Volume of Stroke Interventions: A Nationwide Study in Japan: J-ASPECT Study