Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• The Brain Attack Coalition recommended specialized stroke centers, but a standardized scoring system was absent.
• A Comprehensive Stroke Center (CSC) score was developed and adapted for the Japanese healthcare context.

Purpose of the Study:

• To create and validate a scoring system for Comprehensive Stroke Centers (CSCs) in Japan.
• To assess the relationship between CSC capabilities and patient outcomes.

Main Methods:

• A survey was administered to 749 certified stroke care institutions in Japan.
• A 25-item CSC score was developed, evaluating personnel, diagnostics, expertise, infrastructure, and education.
• Factorial analysis and correlation coefficients were used for validation, alongside analysis of the 2011 Japanese Diagnosis Procedure Combination database.

Main Results:

• The CSC score demonstrated moderate internal consistency (Cronbach's α = 0.765).
• Factorial analysis identified four key constructs: neurovascular surgery/intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care/rehabilitation.
• The CSC score was significantly associated with reduced in-hospital mortality across ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage.

Conclusions:

• The developed CSC score is a valid tool for evaluating stroke center capabilities.
• The score's components, particularly neurovascular surgery, vascular neurology, diagnostic neuroradiology, and critical care/rehabilitation, are crucial for assessing CSCs.