Abstract 306: Regional Differences in Stroke Center Designation and Get with The Guidelines (GWTG-S) Participation and Performance: Results From The NorthEast Cerebrovascular Consortium (NECC)
Authors: Gropen Toby I , Wira Charles R , Melluzzo Shannon , Magdon-Ismail Zainab , Day David , Madsen Tracy , Schwamm Lee H ,   on behalf of NorthEast Cerebrovascular Consortium(NECC)
Published: July 2021

Introduction:
The NorthEast Cerebrovascular Consortium (NECC) was created in 2006 to unite health care providers, public health officials, legislators and advocacy organizations in an 8-state region to implement and assess a Stroke Systems of Care Model.

Objectives:
To examine differences in Primary Stroke Center (PSC) designation, participation in GWTG-S and performance of acute care hospitals (ACH) and critical access centers (CAC) in the NECC region compared to non-NECC regions.

Methods:
We compared percentages of ACHs/CACs with State versus National PSC Designation, GWTG-S participation and Performance Achievement award trends over time in the pre- (2005) and post- NECC (2006-13) time periods. State designation refers to states conducting designation themselves or a combination of their own designation/national designation (Joint Commission, DNV or HFAP). US census data regions were stratified as The NECC region (CT, MA, ME, NH, NJ, NY, RI, VT) vs. Non-NECC regions (PA, South, Midwest, West). ACH/CACs were obtained from CMS. GWTG-S data were used for GWTG-S participation and awards (silver or higher for >1 year).

Results:
Over the study time period (2005-13) the ACH/CACs per year in The NECC and non-NECC regions were 433 + 10 and 4420 + 172. State PSC designation occurred in CT, MA, FL, MD, NJ, and NYS. OK State designation was excluded due to lack of data. In the NECC region, State PSC designation increased over time from 29.3% in 2005 to 63.2% in 2013, compared to 0.1% in 2005 to 3.6% in 2013 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend (CAT)). In the NECC region, National PSC designation increased over time from 2.8% in 2005 to 17.1% in 2013, compared to 35.5% in 2005 to 77.3% in 2013 in non-NECC regions (both analyses p<0.0001, CAT). In the NECC region, GWTG-S participation increased over time from 21.2% in 2005 to 61.5% in 2013 compared to 9.2% in 2005 to 32.4% in 2013 in non-NECC regions (both analyses p<0.0001, CAT), and GWTG-S awards increased over time in the NECC region from 0.5% in 2005 to 42.5% in 2013 compared to 0.1% in 2005 to 16.6% in 2013 in non-NECC regions (both analyses p<0.0001, CAT). After adjusting for year, significantly more NECC ACH/CACs received State PSC designation and significantly more non-NECC ACH/CACs received National PSC designation (both analyses p<0.0001, Cochran-Mantel-Haenszel (CMH)). Significantly more NECC ACH/CACs participated in GWTG-S and received GWTG-S awards than non-NECC ACH/CACs (both analyses p<0.0001, CMH).

Conclusions:
There has been more rapid growth of State in lieu of National PSC certification, and participation and achievement in GWTG-S in the Northeast from 2006 through 2013 compared to other regions in the U.S. The NECC may compliment and enhance existing regulatory and advocacy initiatives. Further investigation is merited to evaluate the influence of regional networks and State versus National PSC designation.