Improving stroke care and outcomes through AHA/ASA primary stroke certification: a pre-post study in Jordan

Stroke remains a major cause of disability and death worldwide. Delays in intervening in the early stages generally lead to longer recovery and negative functional outcomes. Stroke certification standards and evidence-based stroke guidelines, including those advocated by the American Heart Association/American Stroke Association (AHA/ASA), have led to significantly better stroke care and outcomes. However, their use is less applied in middle-income countries such as Jordan. Therefore, this study was conducted to examine the impact of implementing the AHA/ASA primary stroke certification standards on the delivery of stroke care services and patient outcomes in one private accredited hospital in Jordan.

A quasi-experimental pre-post design with non-equivalent groups was used. The study sample included 62 stroke patients, 31 before and 31 after the hospital's certification. Key performance indicators (KPIs) for stroke care, such as timeliness of interventions, in-hospital care quality, secondary prevention, educational programs, early rehabilitation, and clinical outcomes, were compared among the groups using independent-samples t-tests and Chi-square tests.

Implementing certificate standards was associated with improvements across most care indicators. The mean time to CT scan decreased from 29.5 to 14.1 min, and the average time to CT report decreased by 68.3 min. The IV tPA administration for eligible patients with acute ischemic stroke arriving within 4.5 h from symptoms rose from 54.2% to 81.5%. The rate of early rehabilitation initiation increased from 48.4% to 93.5%, and the rate of providing educational materials to patients increased from 9.7% to 90.3%. Patients who achieved good functional outcome at 3 months improved significantly from 29% to 71% (P < .001), with no 30-day readmissions.

Following the implementation of AHA/ASA primary stroke certification standards, we noticed improvements in the process and outcome of care in a small cohort of patients. Findings indicate the success of applying universal stroke protocol in resource-limited contexts and facilitate the scaling up of interventions in Jordanian hospitals to support timely, integrated, and evidence-based stroke care, which may have the potential to reduce costs and ensure sustainable long-term outcomes.