麻豆传媒

Hospitals participating in a national quality improvement program provided better outcomes for patients with acute ischemic stroke, researchers found.

Centers that participated in the Get With The Guidelines-Stroke program had significantly higher rates of patients getting discharged to home and lower rates of mortality at 30 days and 1 year, when compared with similar hospitals that did not join the program, according to Sarah Song, MD, MPH, of Rush University Medical Center in Chicago.

Those advantages were seen both shortly after joining the program and up to 540 days after participation began, Song reported at the American Heart Association's Quality of Care and Outcomes Research meeting in Baltimore.

The study suggests that even for hospitals that are primary stroke centers and are meeting all the quality metrics established by the Centers for Medicare & Medicaid Services (CMS), "this program might have an additional benefit," Song said in an interview. "This could be a really big impetus to join the program, and I think it should be."

Committing to the guidelines is a reflection of a commitment to being prepared to handle acute stroke cases, according to Patrick Lyden, MD, of Cedars-Sinai Medical Center in Los Angeles, which participates in the program.

"I think the data [are] extremely informative to the public," said Lyden, who was not involved in the study. "You want to go to a stroke center that has some form of preparedness and the easiest way to be prepared is to comply with Get With The Guidelines."

Although previous studies have shown that participation in Get With The Guidelines-Stroke is associated with improvement in various processes of care, an attempt had not been made to compare patient outcomes in an analysis matching participating hospitals with similar non-participating centers, Song said.

From a pool of all acute-care hospitals in the U.S., she and her colleagues matched 366 hospitals that joined Get With The Guidelines-Stroke between April 2004 and December 2007 with 366 hospitals that did not based on ischemic stroke case volume, calendar year, 1-year all-cause mortality rates after ischemic stroke at baseline, teaching status, and geographic region.

Information on patient outcomes was taken from a CMS administrative claims database. The analysis included 88,584 Medicare beneficiaries treated at participating centers and 85,401 from non-participating centers. The average patient age was 79.

Looking only at the participating centers, there were significant reductions in the following outcomes when comparing the 540-day period after joining the program with the 540-day period before joining, after adjustment for patient demographics and medical history and hospital characteristics:

• 30-day mortality (HR 0.911, 95% CI 0.880-0.942)
• 1-year mortality (HR 0.902, 95% CI 0.878-0.926)
• Any rehospitalization at 30 days (HR 0.956, 95% CI 0.923-0.990)
• Any rehospitalization at 1 year (HR 0.972, 95% CI 0.953-0.992)
• Rehospitalization for stroke at 30 days (HR 0.927, 95% CI 0.864-0.996)

For non-participating hospitals, on the other hand, the only reduction seen over time occurred in 30-day mortality (HR 0.954, 95% CI 0.921-0.989).

When directly comparing participating and non-participating hospitals, the participating centers had significantly improved rates of discharge to home (HR 1.075, 95% CI 1.060-1.091) and 1-year mortality (HR 0.956, 95% CI 0.930-0.982) over time.

Some limitations of the study included the observational, non-randomized design, a matching process that did not account for all baseline differences between the groups, the possibility of residual confounding, and potential bias stemming from the self-selection of hospitals participating in the Get With The Guidelines-Stroke program.

From the American Heart Association:

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