Circulation: Hospitals using quality program increase compliance to stroke guidelines

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Hospitals participating in a voluntary quality improvement program for stroke treatment increased adherence to national recommendations, according to research published Dec. 15 in Circulation.

In the five-year study, the researchers tracked acute stroke care for hospitalized patient guidelines compliance among hospitals participating in the American Heart Association/American Stroke Association's Get With The Guidelines–Stroke (GWTG–Stroke) program.

The analysis measured adherence to guideline recommendations in 790 hospitals across the U.S. Hospitals volunteered to participate in the study and provided information on 322,847 patients admitted from 2003 to 2007.
They found:

  • Among all possible interventions to prevent another stroke or reduce stroke disability, the overall absolute percentage of interventions performed in eligible patients increased from 83.5 percent in year one to 93.7 percent in year five.
  • For every year of participation, hospitals were 18 percent more likely to deliver guidelines-based care.

The GWTG–Stroke program provides an online interactive assessment and report tool, resources, quarterly workshops, training and feedback to staff at participating hospitals. The goal is to improve implementation of evidence-based interventions that are proven to reduce complications after stroke and the chances of a subsequent stroke or MI.

“Simply publishing guidelines doesn't change physician or patient behavior," said the study’s lead author Lee H. Schwamm, MD, a steering committee member of the GWTG program and vice chairman of neurology at Massachusetts General Hospital in Boston. “Get With The Guidelines–Stroke helps hospitals emphasize the changes necessary to implement the guidelines effectively and consistently.”

The overall composite analysis measured how often hospitals followed seven recommendations for eligible patients. Some of the key recommendations include initiation of intravenous clot-busting drugs within two hours of stroke onset; medication to prevent blood clots within 48 hours of admission and at discharge; antithrombotic treatment for irregular heartbeat and high cholesterol; and counseling to quit smoking.

Among the individual measures, researchers said GWTG–Stroke participation:

  • Increased the absolute percentage of ischemic stroke patients treated with clot-busters within two hours of stroke onset from 42 to 72.8 percent;
  • Increased the absolute percentage of patients beginning smoking cessation from 65.2 to 93.6 percent; and
  • Increased the absolute percentage of patients being started on cholesterol-lowering drugs from 73.3 to 88.3 percent.

The authors said that the study showed that all hospitals improved regardless of size, geography and teaching status. However, they added that there is still significant opportunity for improvement.