During the past decade, primary stroke centers have been established in all 50 states and Washington, D.C., with the goal of improving the care of acute stroke. As of the end of 2013, 32 percent of the short-term adult general hospitals with emergency departments were designated as certified primary stroke centers. 

Ken Uchino, MD, of the Cleveland Clinic, and colleagues published their findings online in Stroke on June 18.

They mentioned the primary stroke center designation has improved thrombolysis utilization rates and mortality. However, they added that more than 147 million people in the U.S. as of 2012 did not have access to hospitals with certified stroke centers.

Of the 1,505 primary stroke centers in the U.S., 74 percent were certified by the Joint Commission and the American Heart Association/American Stroke Association, which began certifying centers in 2003. An additional 20 percent were certified by state health departments, while the rest were certified by the Healthcare Facilities Accreditation Program or Det Norske Veritas.

Across states, the proportion of certified primary stroke centers varied from 4 percent of hospitals in Wyoming to 100 percent of hospitals in Delaware. In the Northeast, 59 percent of hospitals had certified primary stroke centers compared with 32 percent of hospitals in the West, 30 percent of hospitals in the South and 24 percent of hospitals in the Midwest.

From 2004 to 2012, 18 states passed legislation to designate stroke centers. In the states that passed legislation, the median percentage of hospitals with primary stroke centers was 43 percent compared with a median of 13 percent for states without legislation.

“This study demonstrates the important role of state legislation in the stroke system of care in the United States,” Uchino et al wrote. “Many hospitals and regions have the potential to provide standard stroke care if policies are implemented by the state health department.”