Same Hospital, Different Outcomes: Stroke Center Certification Boosts Treatment Rates for White but not Black Patients

A UC San Francisco-led study published in JAMA Network Open on July 30 examined over a decade of data on patients with Medicare hospitalized for acute ischemic stroke. The study found that when hospitals became certified stroke centers, White patients were significantly more likely to receive timely stroke treatments while Black patients saw little to no improvement – even when treated in the same hospital.

“Stroke center certification is intended to improve care quality, but our study shows that not everyone is benefiting equally,” said senior author Dr. Renee Y. Hsia, vice chair for Health Services Research and a professor of Emergency Medicine in the UCSF Department of Emergency Medicine. “When hospitals became certified, White patients were significantly more likely to receive evidence-based treatments, while Black patients saw little to no change.”

The research team analyzed treatment patterns and outcomes among Black and White Medicare beneficiaries from urban areas between 2009 and 2019. By comparing patients treated at the same hospitals before and after certification, the study controlled for facility-level differences and focused squarely on within-hospital disparities. 

Key findings include:

• After hospitals became certified, White patients were 1.7 to 3.8 percentage points more likely to receive thrombolytics, depending on the certification level. Black patients saw no increase in their chances of receiving this treatment, despite being at the same hospitals.
• At the highest level of certification, White patients were 3.7 percentage points more likely to receive mechanical thrombectomy, representing a 506% increase over baseline. Black patients saw only a 1.0 percentage point increase in this procedure – a 137% increase, but still far behind their White counterparts.

The results point to a broader challenge in health equity: Policies designed to elevate quality may not automatically address disparities unless equity is built into their implementation.

“What happens inside the hospital – from triage to treatment decisions – still varies in ways that disproportionately disadvantage Black patients,” Hsia explained. “Certification can open the door to better care, but it doesn't guarantee that care is delivered fairly.”

The study underscores the need for stroke systems of care that prioritize not only access but also accountability. Future work will need to examine how clinical workflows, staffing, and communication practices contribute to unequal care, and what targeted interventions can begin to close the gaps in stroke care, even inside hospitals designed to deliver the highest quality treatment.

Authors
Yu-Chu Shen, PhD, Department of Defense Management, Naval Postgraduate School and National Bureau of Economic Research. Renee Y. Hsia, MD, MSc, Department of Emergency Medicine, UCSF and Philip R. Lee Institute for Health Policy Studies, UCSF. 

Hsia RY, Shen YC. Stroke Center Certification and Within-Hospital Racial Disparities in Treatment. JAMA Netw Open. 2025 Jul 1;8(7):e2524027. doi: 10.1001/jamanetworkopen.2025.24027. PMID: 40736735.