North Carolina stroke prevention and treatment facilities survey - Statewide availability of programs and services

Background/Purpose-The aim of this study was to determine the statewide ava ilability, of facilities and programs for stroke prevention and treatment t o identify underserved regions and target educational efforts. Methods-A single-page survey was mailed to the directors of each inpatient medical facility in North Carolina. Data collected included the availabilit y of selected diagnostic tests, programs, and Services. Facilities were cat egorized as providing basic (emergency department, brain CT, treatment with rtPA, transthoracic echocardiography, carotid ultrasonography, cerebral an giography, carotid endarterectomy) or advanced (basic services:plus brain M RI, MR angiography, transesophageal echocardiography, transcranial Doppler ultrasonography, interventional radiology) services. The availability of ot her programs and services,including having a neurologist on staff, organize d anticoagulation clinics, inpatient rehabilitative services, diffusion-wei ghted MRT, community awareness and rapid stroke identification programs, st roke teams, stroke acute care units or an equivalent, and the use of stroke -care maps, were also determined. Results-Complete responses were obtained from all of the state's 125 inpati ent medical facilities. Overall, 97% of the state's population resided in c ounties with a hospital providing at least some stroke prevention or treatm ent procedures or services. Full basic services were provided by 23 facilit ies located in 19 of the state's 100 counties and were available to 52% of the state's population based on county of residence; advanced services were provided by 8 facilities located in 7 counties and were available to 26% o f the state's population based on county Of residence; Stroke-care maps wer e used in 83% of basic or advanced centers versus 23% of other hospitals (P <0.001), stroke teams were organized in 48% versus 12% (P=0.001), stroke un its or equivalents were available in 61% versus 9% (P<0.001), rapid patient identification programs were in place in 57% versus 9% (P<0.001), and comm unity awareness programs were in place in 57% versus 21% (P=0.005). Conclusions-Only 52% of the state's population reside in counties-with hosp itals providing full basic services; by expanding these services to only 6 additional facilities and thereby encompassing the state's 50 most populous counties, this proportion would be increased to 84%. Services that may imp rove outcomes and reduce costs leg, stroke teams, stroke units, care maps) are not widely used, even in centers with full basic capabilities,Targeting educational efforts to these centers could improve the overall level of st roke care for the majority of the state's population. The study serves as a model that can be applied to other states and regions.