Sarah Song1, Gregg C Fonarow2, DaiWai M Olson2, Li Liang2, Phillip J Schulte2, Adrian F Hernandez2, Eric D Peterson2, Mathew J Reeves2, Eric E Smith2, Lee H Schwamm2, Jeffrey L Saver2. 1. From the Department of Neurology, Rush University Medical Center, Chicago, IL (S.S.); Departments of Cardiology (G.C.F.) and Neurology (J.L.S.), University of California, Los Angeles; Department of Neurology, University of Texas-Southwestern, Dallas (D.M.O.); Departments of Biostatistics and Bioinformatics (L.L., P.J.S.) and Cardiology (A.F.H., E.D.P.), Duke University, Durham, NC; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). sarah_song@rush.edu. 2. From the Department of Neurology, Rush University Medical Center, Chicago, IL (S.S.); Departments of Cardiology (G.C.F.) and Neurology (J.L.S.), University of California, Los Angeles; Department of Neurology, University of Texas-Southwestern, Dallas (D.M.O.); Departments of Biostatistics and Bioinformatics (L.L., P.J.S.) and Cardiology (A.F.H., E.D.P.), Duke University, Durham, NC; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
Abstract
BACKGROUND AND PURPOSE: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. Although studies have suggested improved processes of care in GWTG-Stroke-participating hospitals, it is not known whether this improved care translates into improved clinical outcomes compared with nonparticipating hospitals. METHODS: From all acute care US hospitals caring for Medicare beneficiaries with acute stroke between April 2003 and December 2008, we matched hospitals that joined the GWTG-Stroke program with similar hospitals that did not. Using a difference-in-differences design, we analyzed whether hospital participation in GWTG-Stroke was associated with a greater improvement in clinical outcomes compared with the underlying secular change. RESULTS: The matching algorithm identified 366 GWTG-Stroke-adopting hospitals that cared for 88 584 acute ischemic stroke admissions and 366 non-GWTG-Stroke hospitals that cared for 85 401 acute ischemic stroke admissions. Compared with the Pre period (18-6 months before program implementation), in the Early period (0-6 months after program implementation), GWTG-Stroke hospitals had accelerated increases in discharge to home and reduced mortality at 30 days and 1 year. In the Sustained period (6-18 months after program implementation), the accelerated reduction in mortality at 1 year was sustained, with a trend toward sustained accelerated increase in discharge home. CONCLUSIONS: Hospital adoption of the GWTG-Stroke program was associated with improved functional outcomes at discharge and reduced postdischarge mortality.
BACKGROUND AND PURPOSE: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. Although studies have suggested improved processes of care in GWTG-Stroke-participating hospitals, it is not known whether this improved care translates into improved clinical outcomes compared with nonparticipating hospitals. METHODS: From all acute care US hospitals caring for Medicare beneficiaries with acute stroke between April 2003 and December 2008, we matched hospitals that joined the GWTG-Stroke program with similar hospitals that did not. Using a difference-in-differences design, we analyzed whether hospital participation in GWTG-Stroke was associated with a greater improvement in clinical outcomes compared with the underlying secular change. RESULTS: The matching algorithm identified 366 GWTG-Stroke-adopting hospitals that cared for 88 584 acute ischemic stroke admissions and 366 non-GWTG-Stroke hospitals that cared for 85 401 acute ischemic stroke admissions. Compared with the Pre period (18-6 months before program implementation), in the Early period (0-6 months after program implementation), GWTG-Stroke hospitals had accelerated increases in discharge to home and reduced mortality at 30 days and 1 year. In the Sustained period (6-18 months after program implementation), the accelerated reduction in mortality at 1 year was sustained, with a trend toward sustained accelerated increase in discharge home. CONCLUSIONS: Hospital adoption of the GWTG-Stroke program was associated with improved functional outcomes at discharge and reduced postdischarge mortality.
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