Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke

Fonarow, Gregg C.; Reeves, Mathew J.; Smith, Eric E.; Saver, Jeffrey L.; Zhao, Xin; Olson, DaiWai M.; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.

doi:10.1161/circoutcomes.109.921858

Cited by 308 publications

(307 citation statements)

References 19 publications

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“…It is evident that the amount of time in a program is predictive of process measure compliance. 12 JC certification as a PSC is also associated with increased thrombolytic rates for acute stroke over time. 13 The New Jersey requirements for CSCs, like those of the JC, include a large number of highly trained stroke experts, which ensures more continuous coverage.…”

Section: Discussionmentioning

confidence: 99%

Compliance with joint commission measures in state-designated stroke centers

et al. 2013

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BACKGROUND Comparison of state‐designated primary and comprehensive stroke centers (PSCs and CSCs) with regard to adherence to nationally accepted performance standards are scarce. The objective of this study was to examine if a significant association exists between level of designation and fulfillment of Joint Commission (JC) stroke core measures. METHODS A retrospective comparative data analysis of the New Jersey acute stroke registry for the calendar years 2010 and 2011 was performed. JC core measures were compared by hospital level (PSCs vs CSCs). Adjusted odds ratios (aOR) were estimated for association between hospital levels and fulfillment of JC core measures. Median door‐to‐thrombolytic time was also compared. RESULTS There were 36,892 acute stroke admissions. PSCs had 60% of the patients, whereas CSCs had 40%. Hemorrhagic stroke admissions were about 2 times more frequent at CSCs than PSCs (13.3% and 7.1%, respectively). CSCs adhered better to 6 of the 8 JC measures than PSCs. Of eligible patients, 19.5% received thrombolytic therapy at CSCs compared to 9.6% at PSCs, with a 44% difference in provision of thrombolytic therapy (aOR = 0.28, 95% confidence interval: 0.24‐0.34). Median door‐to‐thrombolytic drug times was 65 minutes at CSCs compared to 74.0 minutes at PSCs (P < 0.0001). CONCLUSIONS New Jersey state‐designated CSCs are better at adhering to the JC core stroke measures and have shorter door‐to‐thrombolytic drug times. Journal of Hospital Medicine 2014;9:88–93. © 2013 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Compliance with joint commission measures in state-designated stroke centers

et al. 2013

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“…Con relación a otros estudios internacionales (EE.UU. (9) y Argentina (10) ) nuestra mortalidad es mayor, pero, puede ser que la comparación no sea definitiva, pues en el estudio estadounidense se incluyó a pacientes con diagnóstico de CIT (casi el 25 % de la muestra) y en el estudio argentino solo evaluaron pacientes con ACV-i que, en general, tiene una menor mortalidad. La falta de una unidad especializada en ACV en el hospital o la falta de implementación de protocolos de administración de terapia trombolítica, pudieran explicar perfectamente estos resultados.…”

Section: Discussionunclassified

“…Este patrón es diferente al que describen fonarow et al (9) en EE.UU., en donde conforme la edad aumenta, se incrementa el riesgo de muerte intrahospitalaria independientemente del tipo de ACV. Este comportamiento no había sido descrito previamente en nuestro medio ni en Latinoamérica y no se puede plantear una única explicación; sin embargo, antes de asimilarlo, se debería impulsar el diseño de un estudio que proporcione información necesaria y razonable que ratifique o deseche este hallazgo, pues se podrían postular una serie de de factores como una mayor gravedad del ACV en pacientes jóvenes, mayor número de registros de ACV como causa de muerte en pacientes jóvenes, el tiempo que demora el paciente en llegar al hospital y la capacidad resolutiva del hospital, entre otros.…”

Section: Discussionunclassified

Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009

Castañeda-Guarderas¹,

Beltrán-Ale²,

Casma-Bustamante³

et al. 2011

Rev Peru Med Exp Salud Publica

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RESUMENEstudio que describe las características de los registros de pacientes con accidente cerebro vascular (ACV), como diagnóstico causante de hospitalización en el Hospital Nacional Cayetano Heredia entre los años 2000 -2009. Se obtuvieron 2225 registros de pacientes mayores de 18 años, con ACV. De acuerdo con la CIE-10, 1071 tenían el diagnóstico de ACV isquémico, 554 ACV hemorrágico, 183 hemorragia subaracnoidea, 49 isquémico hemorrágico, 10 crisis isquémica transitorias y en 358 no fue posible especificar el tipo. Se registraron 352 muertes (19,6 %), la mayoría en los primeros tres días. La razón hombre/mujer fue 1,09; la edad promedio 64,1 ± 17,2 años y la mediana del tiempo de hospitalización fue de nueve días. Las condiciones asociadas más frecuentes fueron hipertensión arterial, fibrilación auricular y diabetes mellitus tipo 2. La mortalidad descrita es la más alta informada en nuestro medio, es constante en todos los grupos de edad y mayor en mujeres.Palabras clave: Accidente cerebrovascular; Epidemiología; Hospitalización (fuente: DeCS BIREME). REGISTRY OF PATIENTS WITH STROKE STATED IN A PUBLIC HOSPITAL OF PERU, 2000-2009 ABSTRACTWe performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA) and in 358 we were unable to specify the type of stroke. 352 deaths were recorded (19.6 %), most of them during the first 3 days. The male / female ratio was 1.09, the mean age 64.1 ± 17.2 years and the median length of hospital stay was 9 days. The most common associated conditions were high blood pressure, atrial fibrillation and type 2 diabetes mellitus. The mortality found is the highest reported in our country, constant in all age groups and higher in women.

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“…The American Heart Association's Get With The Guidelines‐Stroke (GWTG‐Stroke) program has been developed to measure and improve the quality of care and outcome for patients hospitalized with stroke 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. The program provides via performance achievement awards public recognition of hospitals with high performance on select performance measures for acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

“…These measures of achievement include intravenous (IV) tissue plasminogen activator (tPA) within 3 hours (if symptoms onset to door is within 2 hours), use of antithrombotics, timing of antithrombotics, anticoagulation for atrial fibrillation, deep venous thrombosis prophylaxis, low‐density lipoprotein (LDL) <100 mg/dL or statin treatment for patients with LDL ≥100 mg/dL, and smoking cessation counseling. Performance on these achievement measures has reached a high level 1, 2. In contrast, performance on several other quality measures that were not utilized as part of the hospital recognition criteria has been poor 1…”

Section: Introductionmentioning

confidence: 99%

Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care

Heidenreich

Zhao

Hernandez

et al. 2017

JAHA

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BackgroundIn 2009, the Get With The Guidelines‐Stroke (GWTG‐Stroke) program offered additional recognition if hospitals performed well on certain stroke quality measures. We sought to determine whether quality of care for all hospitals participating in GWTG‐Stroke improved with this expanded recognition program.Methods and ResultsWe examined hospital‐level performance on 6 quality of care (process) measures and 1 defect‐free composite quality measure for stroke following expansion of the existing performance measure recognition program. Compliance with all measures improved following launch of the expanded program, and this rate increased significantly for all 9 measures. When evaluated as the relative rate of increase in use over time, process improvement slowed significantly (P<0.05) following launch of the program for 2 measures, and accelerated significantly for 1 measure. However, when evaluated as a gap in care, the decrease in the quality gap was greater following launch of the program for 5 of 6 (83%) measures. There was no evidence that other processes of stroke care suffered as the result of the increase in measures and expanded recognition program.ConclusionsWhile care for stroke continues to improve in this country, expanded hospital process performance recognition had mixed results in accelerating this improvement. However, the quality gap continues to shrink among those participating in provider performance programs.

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Characteristics, Performance Measures, and In-Hospital Outcomes of the First One Million Stroke and Transient Ischemic Attack Admissions in Get With The Guidelines-Stroke

Cited by 308 publications

References 19 publications

Compliance with joint commission measures in state-designated stroke centers

Compliance with joint commission measures in state-designated stroke centers

Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009

Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care

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