Updating on Italian stroke units: the "CCM study"

Area of Science:

• Neurology
• Public Health
• Healthcare Management

Background:

• Stroke units (SUs) are proven effective and cost-efficient for acute stroke care.
• Current implementation of SUs in Italy falls short of expectations, indicating a need for assessment and updates.

Purpose of the Study:

• To assess the current status of in-hospital stroke care across Italian regions.
• To identify the level of stroke unit implementation and adherence to quality indicators.
• To evaluate access to timely thrombolytic therapy.

Main Methods:

• A survey using a semi-structured questionnaire based on 18 stroke care quality indicators.
• Data collected from Italian centers participating in the SITS-MOST study and others identified by experts.
• Statistical analysis included descriptive statistics and logistic regression.

Main Results:

• 153 centers responded, with 137 meeting the definition of a Stroke Unit (SU).
• Most centers (84%) admit 100-500 stroke patients annually. Only 19% treat over 30% of patients within 3 hours of symptom onset.
• Significant territorial heterogeneity observed: 67% of SUs are in Northern Italy, 22% in Central, and only 11% in Southern Italy.
• Thrombolysis rates varied based on on-call doctor availability, with 24-hour doctor presence correlating with higher treatment numbers.
• Despite an overall rise in SUs and thrombolysis, access remains limited in many areas, especially in the South.

Conclusions:

• While the diffusion of SUs and thrombolytic therapy has increased in Italy, significant regional disparities persist.
• Healthcare legislation requirements are unmet in several large areas, particularly in Southern Italy, restricting access to dedicated SUs and timely treatment.
• Further efforts are needed to ensure equitable access to high-quality stroke care throughout Italy.