Yale University School of Medicine, PO Box 208034, New Haven, CT 06520, USA.
Neurology. 2011 Jun 7;76(23):1976-82. doi: 10.1212/WNL.0b013e31821e54f3. Epub 2011 May 4.
The Joint Commission (JC) began certifying primary stroke centers (PSCs) in the United States in 2003. We assessed whether 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates differed between hospitals with and without JC-certified PSCs in 2006.
The study cohort included all fee-for-service Medicare beneficiaries ≥65 years old discharged with a primary diagnosis of ischemic stroke (International Classification of Diseases, ninth revision, Clinical Modification 433, 434, 436) in 2006. Hierarchical linear regression models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, comorbid conditions, and hospital referral region. Hospitals were categorized as being higher than, no different from, or lower than the national average.
There were 310,381 ischemic stroke discharges from 315 JC-certified PSC and 4,231 noncertified hospitals. Mean overall 30-day RSMR and RSRR were 10.9% ± 1.7% and 12.5% ± 1.4%, respectively. The RSMRs of hospitals with JC-certified PSCs were lower than in noncertified hospitals (10.7% ± 1.7% vs 11.0% ± 1.7%), but the RSRRs were comparable (12.5% ± 1.3% vs 12.4% ± 1.7%). Almost half of JC-certified PSC hospitals had RSMRs lower than the national average compared with 19% of noncertified hospitals, but 13% of JC-certified PSC hospitals had lower RSRRs vs 15% of noncertified hospitals.
Hospitals with JC-certified PSCs had lower RSMRs compared with noncertified hospitals in 2006; however, differences were small. Readmission rates were similar between the 2 groups. PSC certification generally identified better-performing hospitals for mortality outcomes, but some hospitals with certified PSCs may have high RSMRs and RSRRs whereas some hospitals without PSCs have low rates. Unmeasured factors may contribute to this heterogeneity.
2003 年，联合委员会（JC）开始在美国认证初级卒中中心（PSC）。我们评估了 2006 年是否存在 JC 认证 PSC 的医院与没有 JC 认证 PSC 的医院之间 30 天风险标准化死亡率（RSMR）和再入院率（RSRR）的差异。
研究队列包括 2006 年所有接受初级诊断为缺血性脑卒中（国际疾病分类，第 9 版，临床修订版 433、434、436）的≥65 岁的全付费医疗保险受益人的出院患者。分层线性回归模型计算了医院层面的 RSMR 和 RSRR，调整了患者人口统计学、合并症和医院转诊区域。医院被归类为高于、等于或低于全国平均水平。
315 家 JC 认证 PSC 医院和 4231 家非认证医院共有 310381 例缺血性脑卒中出院患者。30 天总体 RSMR 和 RSRR 的平均值分别为 10.9%±1.7%和 12.5%±1.4%。JC 认证 PSC 医院的 RSMR 低于非认证医院（10.7%±1.7%比 11.0%±1.7%），但 RSRR 相似（12.5%±1.3%比 12.4%±1.7%）。与非认证医院相比，近一半的 JC 认证 PSC 医院的 RSMR 低于全国平均水平，而 13%的 JC 认证 PSC 医院的 RSRR 低于全国平均水平，而 15%的非认证医院的 RSRR 低于全国平均水平。
2006 年，与非认证医院相比，JC 认证 PSC 医院的 RSMR 较低；然而，差异较小。两组的再入院率相似。PSC 认证通常可以识别死亡率表现较好的医院，但一些具有认证 PSC 的医院可能死亡率和再入院率较高，而一些没有 PSC 的医院则较低。未测量的因素可能导致这种异质性。
