Hospital Treatment of Patients With Ischemic Stroke or Transient Ischemic Attack Using the “Get With The Guidelines” Program

Abstract

Background: Adherence to evidence-based interven- tions for hospitalized patients who have experienced a strokeissuboptimal.Weexaminedtheassociationofpro- cessimprovementandInternet-baseddatacollectionand decision support with stroke care. Methods: A 1-year intervention study to assess perfor- mance measure adherence in hospitals using the "Get WithTheGuidelines-Stroke"program.Theprogramin- cluded 18410 patients with ischemic stroke or tran- sient ischemic attack admitted to 99 volunteer commu- nity and teaching hospitals. Data from eligible patients inthepreinterventionbaselineperiodwerecomparedwith data from 4 subsequent quarters for 12 acute care or sec- ondary prevention measures and an all-or-none mea- sure of care based on 7 prespecified measures. Results: Significant improvements from baseline to the fourth quarter were seen in 11 of 13 measures: use of thrombolyticmedicationsforpatientswithischemicstroke presenting within 2 hours of onset, 23.5% vs 40.8% (P.001);earlyuseofantithromboticmedications,88.2% vs 95.2% (P.001); antithrombotic medications pre- scribed at discharge, 91.0% vs 97.9% (P.001); antico- agulation agents for atrial fibrillation, 81.4% vs 96.5% (P.001);smokingcessationcounseling,38.3%vs54.5% (P.001);lipidtreatmentforlow-densitylipoproteinlev- els100mg/dLorgreater,58.7%vs77.0%(P.001);dia- betes mellitus treatment, 48.5% vs 83.5% (P=.001); and weight reduction counseling 32.5% vs 43.4% (P.001). The all-or-none measure increased from 50.2% to 58.0% (P.001). Complications from thrombolytic medica- tions and prophylaxis for deep venous thrombosis did not change. Conclusion: Statistically and clinically significant im- provementin11of13qualityimprovementmeasuresfor the treatment of patients hospitalized for cerebrovascu- lar disease was seen in hospitals participating in the Get With The Guidelines program.