An increase in eligible
patients receiving care based on the Get with the Guidelines-Stroke program was
cited as the major reason for the performance improvement found among hospitals
examined in a recent study.
Specifically, hospital participation with the program
substantially improved the quality of care of patients with ischemic stroke
during a 7-year period.
In the study, researchers analyzed data on patients
(n=569,883; median age, 73 years) admitted with ischemic stroke to Get with the
Guidelines (GWTG)-Stroke hospitals (n=1,028) from April 2003 to September 2009.
Performance measures that were deemed relevant for patients with acute ischemic
stroke included early and discharge antithrombotics, deep vein thrombosis
prophylaxis, anticoagulants for
atrial fibrillation/flutter, lipid therapy, smoking cessation
and IV recombinant tissue plasminogen activator therapy.
Although noting minimal changes to the size of the
target population in six of the measures, the researchers found that deep vein
thrombosis prophylaxis population reduced from 52.5% to 46.8%. This, they said,
was due to change in the data collection tool, particularly a format change in
the 2008 form that decreased the number of patients identified as nonambulatory
by day 2.
Additionally, across the study period, all measures had
significant increases in eligible patients, most of which occurred without
major shifts in contraindications or missing data, the researchers wrote.
“The results of the present study have important
implications for other CV quality improvement programs that measure and track
the quality of care through process-based performance measures,” they
said. “Our results strongly suggest that the
GWTG-Stroke quality improvement program increased the number
of eligible patients who received guideline-based care during this period,
which to the extent that these care processes are clinically effective should
result in meaningful improvements in stroke outcomes.”