State laws have played a big part in boosting the number of hospitals where specialized stroke care is available, a new study shows.

During the study, the increase in the number of hospitals certified as primary stroke centers was more than twice as high in states with stroke legislation as in states without similar laws.

At these hospitals, a dedicated stroke-focused program staffed by professionals with special training delivers emergency therapy rapidly and reliably.

All hospitals should be able to see patients with stroke, but PSC certification attests to quality of care, said lead author Dr. Ken Uchino of the Cleveland Clinic.

“It takes money and effort to organize quality care,” he told Reuters Health by email. “Sometimes a hospital is so small that the facility does not expect many patients with stroke to arrive. Sometimes the resources to provide quality care are not available, such as radiology technicians on call to run a CT scanner 24 hours a day or a specialist physician in the community.”

U.S. organizations first began certifying stroke centers in 2003. Some states developed their own certification programs, and many passed laws requiring ambulance personnel to take an acute stroke patient directly to a certified center, bypassing hospitals that are not certified.

These laws seem to have encouraged more hospitals to get certification, according to a paper online now in the journal Stroke.

Between 2009 and 2013, states with stroke legislation had a 16% increase in PSC certification, compared to a 6% increase in states without similar legislation.

“I think if a hospital administrator realizes that an ambulance might bypass his or her hospital because it is not stroke-certified, there is an incentive to organize stroke care in the hospital and have stroke center certification,” Uchino said.

By 2013, about a third of short-term adult general hospitals with emergency departments in the U.S. were certified as primary stroke centers, he said. But growth rates have varied by state, and by 2013 there were still three states with only one certified center, he said.

Out of 4,640 general hospitals with emergency rooms in the country, 1,505 have been certified as primary stroke centers following action by state legislatures. But the proportion of stroke centers by state still varied from as low as 4% in Wyoming, which has no stroke legislation, to 100% in Delaware, which does have stroke laws.

“Massachusetts, Florida, and New Jersey, which passed stroke legislation in 2004, had 74 to 97% of the hospitals certified as stroke centers by 2013,” Uchino said.

Larger, more urban hospitals in states with higher economic output are most likely to be certified as primary stroke centers, the researchers found.

Patients brought to a certified stroke center have a better chance of survival than those brought elsewhere, Uchino said.

Almost all large hospitals can and should be stroke centers, and small hospitals still need help to improve, he said.

“Small hospitals still can become stroke centers, but they had to be creative with how they pulled resources together,” said Dr. Lee H. Schwamm of Massachusetts General Hospital and Harvard Medical School in Boston.

“Every community should have at least one” primary stroke center, Schwamm, who was not part of the new study, told Reuters Health by phone. “The real challenge is how do I ensure equitable access for people all over the country.”

Small rural hospitals may struggle to have access to stroke expertise, but that may be overcome with telemedicine, if stroke experts elsewhere are available by remote link, he said.

Individual advocacy can make a difference in access to stroke care, he said.

“If you live in a community, go look up your hospital online and see if it’s participating in a national stroke quality program and if it is certified by a state or national body,” Schwamm said. “If your hospital isn’t certified or doesn’t have this, pressure your hospital, ask your doctor why not.”