mark j. alberts, mdnorthwestern university jean range, msthe joint commission
DESCRIPTION
The Impact of Joint Commission Primary Stroke Center Certification on Administration Rate of IV TPA to Eligible Patients. Mark J. Alberts, MDNorthwestern University Jean Range, MSThe Joint Commission Ann Watt, MBAThe Joint Commission Vicki Cantwell, MBAThe Joint Commission - PowerPoint PPT PresentationTRANSCRIPT
Mark J. Alberts, MD Northwestern UniversityJean Range, MS The Joint CommissionAnn Watt, MBA The Joint CommissionVicki Cantwell, MBA The Joint CommissionJoe Troy, MS The Joint Commission
Introduction
TJC has been certifying Primary Stroke Centers since 2003
The use of IV TPA to treat eligible patients with acute ischemic strokes is one important aspect of care at a PSC, but certainly not the main reason to become a PSC
IV TPA remains one of the few FDA-approved treatments for acute ischemic stroke
IV TPA is included in all acute stroke care guidelines
MethodsData obtained through TJC files (site visits and
disease performance measures)2008 data
Data also obtained from AHA Helthcare Quick-Disc 2008 edition
TPA administration defined as patient presentation within 120 minutes of time last known wellIV TPA administered within 180 minutesPatients met inclusion/exclusion criteria used by
hospital/guidelinesCorrelated TPA use with cycles of certification and
type of facility
Results
Data available from 418 PSCs251 teaching and 154 non-teaching200 certified within past 2 years (1st
cycle)197 in their second certification cycle21 are in their third certification cycle
1902 of 2469 total eligible patients received TPA 77% utilization rate
Overall Rates of TPA Utilization and Cycle
Cycle Number TPA Use
1 72.7%
2 78.6%
3 94.4%
P = 0.03 for one to three cycle comparison
Rates of TPA UtilizationTeaching vs Non-Teaching Hospitals
TJC classifies hospitals into 3 categoriesMajor teachingMinor teachingNon-teaching
Most certified PSCs (71%) are either non-teaching or minor teaching hospitals
Rates of TPA UtilizationTeaching vs Non-Teaching Hospitals
70% use of TPA in non-teaching hospitals
81% rate of TPA use in major or minor teaching hospitals
11% absolute difference in rate of TPA utilization
This is only among eligible patients
P < 0.05
Number of Hospitals per Cycle
Number of Treated Patients per Cycle
Number of Patients Treated per Hospital
Rates of TPA Use, Hospital Type, and Cycles
Cycle 1 Cycle 2 Cycle 3
Teaching 78% 80% 94%
Non-Teach 67% 74% 100%
Difference - 11% - 6% + 6%
Trends Over Time in Percent Eligible Treated
Discussion Points
Higher rates of TPA use in teaching hospitals could be due to a number of factors:Availability of stroke teams 24/7Familiarity with TPA protocolImproved guidance from fellows and attendingBetter patient acceptance
Discussion Points
Increase in TPA use with increased recertification cycles:More experience and comfort among medical
staffMore efficient care leading to fewer treatment
delaysImproved marketing of stroke center and its
programs May increase the number of overall eligible patients
Discussion Points
What accounts for the narrowing of treatment rates between teaching and non-teaching facilities?Was due largely to gains at the non-teaching
hospitals But both groups showed improvements
Demonstrates that experience matters!!Perhaps diversion of acute patients to specific
facilities leads to improved care efficiency, comfort levels, and program development
Limitations
Much of the data obtained from databasesMuch of the data generated by self-reporting
Few audited resultsWe did not analyze nor control for many
confounding factors:Risk stratificationSESReasons for exclusion from treatmentAscertainment biases
Conclusions
TPA utilization at certified PSCs is associated with the duration of time a hospital has been a Stroke Center
While TPA utilization is higher initially at teaching hospitals, over time the non-teaching hospitals are able to achieve high levels of TPA use
Experienced teaching hospitals have the highest rate of TPA utilization
Conclusions
These data further support the importance of PSCs and how time and experience improve some aspects of acute stroke care
The vast majority of patients at a PSC do not receive TPA, but still benefit from other aspects of organized care at these facilities