Department of Emergency Medicine (M.F., R.Y.H.), University of California, San Francisco.
Department of Neurology, UCSF Weill Institute of Neurosciences (A.S.K.), University of California, San Francisco.
Stroke. 2024 Apr;55(4):1051-1058. doi: 10.1161/STROKEAHA.123.045368. Epub 2024 Mar 12.
Stroke centers are critical for the timely diagnosis and treatment of acute stroke and have been associated with improved treatment and outcomes; however, variability exists in the definitions and processes used to certify and designate these centers. Our study categorizes state stroke center certification and designation processes and provides examples of state processes across the United States, specifically in states with independent designation processes that do not rely on national certification.
In this cross-sectional study from September 2022 to April 2023, we used peer-reviewed literature, primary source documents from states, and communication with state officials in all 50 states to capture each state's process for stroke center certification and designation. We categorized this information and outlined examples of processes in each category.
Our cross-sectional study of state-level stroke center certification and designation processes across states reveals significant heterogeneity in the terminology used to describe state processes and the processes themselves. We identify 3 main categories of state processes: No State Certification or Designation Process (category A; n=12), State Designation Reliant on National Certification Only (category B; n=24), and State Has Option for Self-Certification or Independent Designation (category C; n=14). Furthermore, we describe 3 subcategories of self-certification or independent state designation processes: State Relies on Self-Certification or Independent Designation for Acute Stroke Ready Hospital or Equivalent (category C1; n=3), State Has Hybrid Model for Acute Stroke Ready Hospital or Equivalent (category C2; n=5), and State Has Hybrid Model for Primary Stroke Center and Above (category C3; n=6).
Our study found significant heterogeneity in state-level processes. A better understanding of how these differences may impact the rigor of each process and clinical performance of stroke centers is worthy of further investigation.
卒中中心对于急性卒中的及时诊断和治疗至关重要，并且与改善治疗效果和预后相关；然而，用于认证和指定这些中心的定义和流程存在差异。我们的研究对州卒中中心认证和指定流程进行了分类，并提供了美国各州的流程示例，特别是在不依赖国家认证的独立指定流程的州。
在这项 2022 年 9 月至 2023 年 4 月的横断面研究中，我们使用同行评议文献、州内的主要来源文件以及与全美 50 个州的州官员进行沟通，以获取每个州卒中中心认证和指定流程的信息。我们对这些信息进行了分类，并概述了每个类别中的流程示例。
我们对各州卒中中心认证和指定流程的横断面研究表明，用于描述州流程和流程本身的术语存在显著差异。我们确定了 3 种主要的州流程类别：无州认证或指定流程（类别 A；n=12）、州指定仅依赖于国家认证（类别 B；n=24）和州有自我认证或独立指定的选择（类别 C；n=14）。此外，我们描述了 3 种自我认证或独立州指定流程的子类别：州依赖于自我认证或独立指定来确定急性卒中准备医院或同等医院（类别 C1；n=3）、州具有急性卒中准备医院或同等医院的混合模式（类别 C2；n=5）和州具有混合模式的初级卒中中心和以上等级（类别 C3；n=6）。
我们的研究发现州级流程存在显著差异。进一步研究这些差异如何影响每个流程的严格程度以及卒中中心的临床表现是值得的。
