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Systemization of advanced stroke care: the dollars and sense of comprehensive stroke centers
  1. Nazli Janjua1,2,
  2. Adnan I Qureshi3,
  3. Osama O Zaidat4
  1. 1Asia Pacific Comprehensive Stroke Institute, Claremont, California, USA
  2. 2Lutheran Medical Center, Brooklyn, New York, USA
  3. 3Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
  4. 4Departments of Neurology, Neurosurgery, and Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  1. Correspondence to Dr N Janjua, Lutheran Medical Center, Brooklyn, NY 11201, USA; Nazli.janjua{at}apcsi.org

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Introduction

Stroke center designation is an integral component of maintaining the systems of care for cerebrovascular diseases.1 Organization of hospitals into efficient vehicles of healthcare delivery helps improve clinical outcomes.2 The approval of IV tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) highlighted the need for specialized stroke centers able to quickly mobilize all aspects of care to administer this treatment, due to its strict time window of administration.3 ,4 This led to primary stroke center (PSC) designation. Just as with cardiac ‘STEMI’ (ST segment elevation myocardial infarction) centers, which have increased performance of life saving percutaneous coronary intervention for acute myocardial infarction,5 ,6 PSCs have increased IV tPA utilization.2 ,7 Treatments for cerebrovascular conditions using specialized procedures, such as cerebral aneurysms, require yet additional galvanization of resources. Criteria proposed for PSCs do not specifically mandate neurointerventional availability,8 but the success of the PSC designation process extended itself to designation of comprehensive stroke centers (CSCs) which would possess these (and other) capabilities.9 ,10 A pathway for advanced accreditation of CSCs has been adopted by the Joint Commission (JC) for Hospital Accreditation.11

The current budgetary climate favors centralization of resources; directing care to specific designated stroke centers makes fiscal sense. Sequestering stroke patients in CSCs, which possess the necessary personnel and equipment to provide multimodal treatment, benefits the patient and also spares non-CSC facilities from disbursing these resources, which may be more limited, to patients for whom definitive care is ultimately lacking in their centers.

Many hospitals find themselves de facto stroke centers, as forced closures of other neighboring institutions increase their own stroke admission volumes. These hospitals therefore bear responsibility to the communities they serve to fulfill the standards deserving of stroke center designation. Identifying centers able to …

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