Statewide assessment of hospital-based stroke prevention and treatment services in North Carolina - Changes over the last 5 years

Background and Purpose-The first published statewide assessment of stroke prevention and treatment services in the United States was carried out in North Carolina in 1998. The purpose of the present study was to measure changes in these services that may have occurred over the last 5 years. Methods-A 1-page questionnaire was sent to each facility in the state in February 2003. Results were compared with the 1998 survey. Results-Complete responses were obtained from each of the state's 128 facilities. The proportions of hospitals providing CT angiography (35% versus 55%, Pless than or equal to0.01), diffusion-weighted MRI (20% versus 45%, Pless than or equal to0.01), transesophageal echocardiography (45% versus 59%, Pless than or equal to0.02), and inpatient rehabilitation services (25% versus 43%, Pless than or equal to0.01) increased over the 5 years. There was a trend toward more facilities having tissue plasminogen activator protocols (43% versus 54%, Pless than or equal to0.09) but a decrease in the proportion of hospitals with interventional radiologists (23% versus 15%, P<0.01). There was no change in the proportion of the state's population living in a county with a basic stroke prevention and treatment center, with the proportion residing in a county with an advanced center increasing by 12%. Entire regions of the state lacked either type of center, and only 14% had even the essential infrastructure recommended for a Brain Attack Coalition-type primary stroke center. There was no difference in the proportions of hospitals with organized stroke teams, those having a stroke acute care unit, those using stroke care maps, or hospitals having community awareness programs. Conclusions-Certain technologies have become more widely available, but hospital investments in stroke-related programs have not appreciably increased.