The impact of comprehensive stroke care capacity on the hospital volume of stroke interventions: a nationwide study in Japan: J-ASPECT study

J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):1001-18. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.016. Epub 2013 Oct 6.


Background: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions.

Methods: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009.

Results: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001).

Conclusion: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan.

Keywords: Stroke facilities; acute stroke therapy; intracerebral hemorrhage; ischemic stroke; stroke units; subarachnoid hemorrhage.

Publication types

  • Multicenter Study

MeSH terms

  • Comprehensive Health Care / trends*
  • Delivery of Health Care, Integrated / trends
  • Embolization, Therapeutic / trends
  • Fibrinolytic Agents / administration & dosage
  • Health Care Surveys
  • Health Services Accessibility / trends
  • Healthcare Disparities / trends
  • Hospitals, High-Volume / trends*
  • Hospitals, Low-Volume / trends*
  • Humans
  • Japan
  • Linear Models
  • Multivariate Analysis
  • Neurosurgical Procedures / trends
  • Outcome and Process Assessment, Health Care / trends*
  • Patient Care Team / trends
  • Stroke / diagnosis
  • Stroke / therapy*
  • Surveys and Questionnaires
  • Thrombolytic Therapy / trends
  • Tissue Plasminogen Activator / administration & dosage
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator