Potential reason for improved outcome found with GWTG-Stroke program

Reeves MJ. Circ Cardiovasc Qual Outcomes. 2011;doi:10.1161/circoutcomes.111.961755.

Issue: October 2011

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.”

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