Stroke care is better at hospitals participating in GWTG-Stroke

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Takeaway

Why this matters

  • Outcomes are better with evidence-based care, but adherence varies.

Key results

  • 38% of patients treated in hospitals participating in GWTG-Stroke.
  • Patients treated at participating vs nonparticipating hospitals more likely to receive:
    • 5 of 10 recommended evidence-based interventions, including tissue plasminogen activator (relative risk, 3.74; 95% CI, 1.65-8.50);
    • Education on risk factors (1.54; 1.16-2.05);
    • Evaluation for swallowing (1.25; 1.04-1.50);
    • Lipid evaluation (1.18; 1.05-1.32); and
    • Evaluation by neurologist (1.12; 1.05-1.20).
  • Mean number of interventions received was greater at participating hospitals (5.4 vs 4.8; P
  • Editorial: Small and rural hospitals may lack resources for GWTG-Stroke participation. “This requires a shift in focus from hospital-level improvement to regional stroke systems of care to ensure that all patients have access to high-quality stroke care.”

Study design

  • Prospective population-based cohort study of 546 patients experiencing ischemic stroke during 9-year follow-up of REGARDS Study.
  • Main outcomes: quality-of-care measures.
  • Funding: National Institute of Neurological Disorders and Stroke; American Stroke Association; Janssen Pharmaceutical Companies Johnson & Johnson; others.

Limitations

  • Reliance on medical records.
  • Residual confounding.