New Data Provides Roadmap for Stroke Care in North Carolina
Ten years of statewide data on stroke prevention and treatment services in North Carolina will provide a map for future care, according to Duke University Medical Center research.
“The ultimate goal is to have it organized so that no matter where a patient in North Carolina has a stroke, they have access to the most readily available state-of-the-art acute treatment,” said Larry B. Goldstein, MD, director of Duke University Medical Center’s Stroke Center and lead author of the research.
Goldstein led a survey in 1998, 2003, and 2008 that asked every hospital in North Carolina to complete a two-page questionnaire. The North Carolina Stroke Prevention and Treatment Facilities Survey was supported through a grant from the North Carolina Department of Health and Human Services.
Surveys from 1998 and 2003 show some tests useful for the evaluation of stroke patients became more widely available in the state, but basic organizational features for stroke care -- the use of stroke care maps, protocols for intravenous tissue plasminogen activatpor (tPA) and stroke teams -- did not change at all, Goldstein said.
In 1998, only 18 percent of the state’s hospitals met basic criteria for stroke care. The number increased slightly to 21 percent in 2003, and now about 40 percent of the population lives in a county with at least one Primary Stroke Center.
The results are published online in Stroke and Goldstein will present the data at the International Stroke Conference in San Antonio, Texas on Wednesday, February 24, 2010.
“This information shows not only the changes that have occurred in North Carolina over a 10-year period, but provides information to help statewide planning so that stroke patients will have the quickest care possible,” Goldstein said.
Anyone suffering a stroke needs to be able to reach a hospital that’s equipped and organized to care for people with acute stroke as quickly as possible, he said. “With stroke care, time lost is brain lost.”
The American Heart Association has placed an emphasis on promoting statewide systems for stroke care. The AHA’s goal involves educating a continuum of people involved with stroke care, including the public, emergency medical services, and facilities equipped to care for a stroke patient.
Some counties have no acute care hospitals, so how that county organizes its plan to transport stroke patients to the nearest facility is going to be different than in a county where there are several different facilities available, Goldstein said.
In January, North Carolina Emergency Medical Services began requiring every EMS provider in the state to have a plan for how they are going to transport potential stroke patients to the nearest appropriate facility.
“This new comprehensive data establishes a roadmap for stroke care available in North Carolina,” Goldstein said.
“By clustering the organizational features within a specific hospital, we developed a basic set of criteria that a hospital would need to be able to provide optimal basic care for a stroke patient,” Goldstein said.
Although the organizational features improved for many basic stroke centers between 2003 and 2008, the number of patients with access to a basic stroke center stayed flat or even declined, he said.
This information is going to be used by the North Carolina Stroke Advisory Council as it promotes the development of stroke systems in the state, he said. In 2006, the North Carolina legislature established the council charged with promoting the development of coordinated stroke care in the state.
The survey data can help statewide planning for establishing Primary Stroke Centers and locating basic stroke care facilities to provide acute stroke management even though they may not have all the bells and whistles, the money or an infrastructure to support Primary Stroke Center designation, Goldstein said.
This is already happening regionally, he said. “There is now a Primary Stroke Center at East Carolina University’s Pitt County Memorial Hospital, where there was basically nothing east of Raleigh in 2003.”
Having this type of information could really help direct us as we try to develop that organized system of stroke care throughout the state of North Carolina, he said. “This is really intended to help guide our planning and has served as a model for other states and countries.”