Researchers from the University of Alabama at Birmingham School of Public Health joined with others to determine whether the quality of stroke care was better at hospitals who participated in Get With the Guidelines-Stroke program. Dr. George Howard, professor, and Mr. David Rhodes, MPH, program director from the department of biostatistics, and Dr. Virginia Howard, professor in the department of epidemiology made up the team from UAB.
The Get With The Guidelines–Stroke (GWTG-Stroke) is an American Heart Association/American Stroke Association stroke-care quality-improvement program.
Subpopulation of 546 participants with ischemic stroke occurring during a 9-year follow-up of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a population-based cohort study of 30, 239 randomly selected black and white participants 45 years and older recruited between 2003 and 2007. Of those with stroke, 207 (36 percent) were treated in a hospital participating in GWTG-Stroke and 339 in a nonparticipating hospital. Data were analyzed between July 29, 2017, and April 17, 2018.
Quality of care measures including use of tissue plasminogen activator, performance of swallowing evaluation, antithrombotic use in first 48 hours, lipid profile assessment, discharge receiving antithrombotic therapy, discharge receiving a statin, neurologist evaluation, providing weight loss and exercise counseling, education on stroke risk factors and warning signs, and assessment for rehabilitation.
Participants treated at participating hospitals had a mean (SD) age of 74 (8) years and 100 of 207 were men (48 percent), while those seen at nonparticipating hospitals had a mean (SD) age of 73 (9) years, and 161 of 339 were men (48 percent). Those seen in participating hospitals were more likely to receive 5 of 10 evidence-based interventions recommended for patients hospitalized with ischemic stroke, including receiving tissue plasminogen activator (RR, 3.74; 95 percent CI, 1.65-8.50), education on risk factors (RR, 1.54; 95 percent CI, 1.16-2.05), having an evaluation for swallowing (RR, 1.25; 95 percent CI, 1.04-1.50), a lipid evaluation (RR, 1.18; 95 percent CI, 1.05-1.32), and an evaluation by a neurologist (RR, 1.12; 95 percent CI, 1.05-1.20). Those seen in participating hospitals received a mean of 5.4 (95 percent CI, 5.2-5.6) interventions compared with 4.8 (95 percent CI, 4.6-5.0) in nonparticipating hospitals (P < .001).
The researchers concluded that these data collected independently of the GWTG-Stroke program document improved stroke care for patients with ischemic stroke hospitalized at participating hospitals.