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There can be no doubt that we are getting better at treating stroke patients. According to the 2011 Heart Disease and Stroke Statistics Update, from 1997 to 2007 the annual stroke death rate decreased 34.3% and the actual number of stroke deaths declined 18.8%.1 Stroke center implementation may have contributed to these improvements. Ten years ago, the Brain Attack Coalition introduced recommendations for the establishment of primary stroke centers (PSCs)2 and the Joint Commission (JC) subsequently began certifying PSCs in 2003. In 2007, the Stroke Unit Trialists' Collaboration reported that patients with strokes treated in a stroke unit had better outcomes than those who did not.3 A recent study of state-designated stroke-certified hospitals in New York also found a lower 30-day mortality and readmission rate compared with noncertified hospitals.4 To date, data specifically regarding outcomes in JC-certified hospitals have been lacking.
In this issue of Neurology®, Lichtman et al.5 compare the 30-day risk-standardized mortality and readmission rates in JC-certified hospitals in 2006 with …
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