Background and Purpose
The Joint Commission (JC) began certifying Primary Stroke Centers in November, 2003. Cross-sectional studies assessing the impact of certification could be biased if these centers had better outcomes prior to the start of the program. We determined whether hospitals certified within the first years of the JC program had better outcomes than non-certified hospitals prior to the start of the certification program.
The study sample included Medicare fee-for-service beneficiaries ≥65 years of age discharged with ischemic stroke in 2002 from 5070 hospitals, 317 of which were JC-certified by June, 2007. Hierarchical logistic regression and Cox proportional hazards models were used to compare in-hospital and 30-day mortalities and 30-day readmission for patients treated at future JC-certified versus non-certified hospitals.
Among 366,551 patients, 18% (66,300) were treated at hospitals with centers that were JC-certified within the first few years of the program. These patients were younger, more likely to be white and male, and had fewer comorbidities and hospitalizations within the prior year. Unadjusted in-hospital mortality (4.7% vs. 5.5%), 30-day mortality (9.8% vs. 11.3%) and readmissions (13.8% vs. 14.6%) were lower in the future JC-certified hospitals (all p<0.001). These differences remained after risk adjustment (in-hospital mortality, OR=0.93, 95%CI 0.90–0.96; 30-day mortality, OR=0.92, 95%CI 0.87–0.96; 30-day readmission, HR=0.97, 95%CI 0.95–0.99).
JC Primary Stroke Center-certified hospitals had better outcomes than non-certified hospitals even before the program began. Cross-sectional studies assessing the effects of stroke center certification need to account for these pre-existing differences.
Keywords: ischemic stroke, certified stroke center, outcomes