Background: Geographic variation in healthcare quality, including an urban-rural difference, is well recognized. For stroke care, we were interested in the relationship with stroke center certification and access to neurological services.
Hypothesis: We assessed the hypothesis that the use of thrombolytic therapy (t-PA) is associated with stroke certification level and access to neurological services.
Methods: Performance measure data in the 2015 Hospital Compare, a CMS quality reporting system, were used to document the gap in care quality among hospitals according to large, medium, small-metro, and non-metro areas and Joint Commission (JC) certification. Regression analysis was used to estimate the association between t-PA use and certification level or access to neurological services.
Results: On average, non-metro hospitals performed worse than metro hospitals on JC-endorsed stroke quality measures; the biggest disparity was in the use of t-PA for eligible patients arriving within 2 hours (STK-4). Certified stroke centers in every geographic designation provided higher quality of care; however, a large variation was observed among non-certified hospitals (Figure). Regression analysis suggested that improvements in certification or access were associated with 45% and 21% absolute improvements, respectively, in the percent of patients receiving t-PA (Table).
Conclusion: The large quality gap in stroke care between metro and non-metro areas can, in part, be addressed by approaches to achieve stroke center certification or to adopt decision support systems such as telemedicine.