Weekend Discharge and Stroke Quality of Care: Get With The Guidelines-Stroke Data from a Comprehensive Stroke Center

Introduction: The American Heart Association (AHA) recently raised the bar on timely treatment of acute ischemic stroke (AIS) with intravenous (IV) alteplase, by recommending door-to-needle times of 30 minutes or less for 50% or more of the AIS patients. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times on efficiency and quality of care, and clinical outcomes. Methods: Our study examined 762 AIS patients treated with IV alteplase in a large academic health system from 2015-2018, and compared their outcomes after treatment within 30, 45 and 60 minutes of arrival. The outcomes compared were: 1) Efficiency of care outcome - Length of stay (LOS); 2) Quality of care outcomes - Inpatient mortality and Disability at discharge; 3) Clinical outcomes - Discharge and 90-day modified Rankin Scale (mRS), and Post-alteplase (24 hr) NIH Stroke Scale (NIHSS). Adjusted logistic and linear regression analyses were used, after controlling for baseline patient socio-demographic and clinical characteristics. Results: Based on the adjusted regression analyses (Table 1), being treated within 30 minutes of arrival reduced the average LOS by 1.3 days (p-value: 0.02), but did not affect the quality of care outcomes. Similarly, being treated within 45 minutes of arrival reduced LOS by 0.9 days (p-value: 0.04). Being treated within 60 minutes of arrival did not affect LOS, but reduced the odds of inpatient mortality by 68% (p-value: 0.00), and disability at discharge by 29% (p-value: 0.08). Being treated within 30 minutes of arrival was associated with better mRS and NIHSS scores as compared with being treated within 45 or 60 minutes. Conclusion: Quicker IV alteplase treatment significantly improved efficiency of care and clinical outcomes. Quality of care outcomes did not improve beyond the 60 minute door-to-needle threshold. This study provides evidence supporting AHA’s new recommendation of 30 minutes or less door-to-needle time.

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Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic

Stroke ◽

10.1161/strokeaha.120.031300 ◽

2021 ◽

Vol 52 (4) ◽

pp. 1398-1406 ◽

Cited By ~ 1

Author(s):

Mark R. Etherton ◽

Kori S. Zachrison ◽

Zhiyu Yan ◽

Lukas Sveikata ◽

Martin Bretzner ◽

...

Keyword(s):

Ischemic Stroke ◽

Quality Of Care ◽

Stroke Patient ◽

Regional Analysis ◽

Clinical Severity ◽

Stroke Severity ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Patient Presentation

Background and Purpose: Patient care-seeking has likely changed during the coronavirus disease 2019 (COVID-19) pandemic. In stroke, delayed or avoided care may translate to substantial morbidity. We sought to determine the effect of the pandemic on patterns of stroke patient presentation and quality of care. Methods: We analyzed data from 25 New England hospitals: one urban, academic comprehensive stroke center and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes, and all stroke admissions to the comprehensive stroke center hub from November 1, 2019 through April 30, 2020. We compared rates of presentation, timeliness presentation, and quality of care pre- versus post-March 1, 2020. We examined trends in patient demographics, stroke severity, timeliness, diagnoses including large vessel occlusion, alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- versus post-March 1, 2020 and used linear regression to examine trends over time. Results: Among 1248 patient presentations (844 telestroke consultations, 404 comprehensive stroke center admissions), telestroke consultations and ischemic stroke patient admissions decreased among the spokes and hub. Age and stroke severity were unchanged over the study period. We found no change in alteplase administration at telestroke spoke hospitals but did note a decrease in both alteplase use and thrombectomy at our comprehensive stroke center. Time metrics for patient presentation and care delivery were unchanged; however, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic. Conclusions: In this regional analysis, we found decreasing telestroke consultations and ischemic stroke admissions, and reduced performance on stroke quality of care measures during the COVID-19 pandemic. Contrary to prior reports, we did not find an increase in thrombectomy nor decrease in clinical severity that might be expected if patients with milder symptoms avoided hospitalization.

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Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations

Stroke ◽

10.1161/str.0b013e318208eb99 ◽

2011 ◽

Vol 42 (3) ◽

pp. 849-877 ◽

Cited By ~ 113

Author(s):

Dana Leifer ◽

Dawn M. Bravata ◽

J.J. (Buddy) Connors ◽

Judith A. Hinchey ◽

Edward C. Jauch ◽

...

Keyword(s):

Quality Of Care ◽

Comprehensive Stroke Center ◽

Stroke Center

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Association of Electronic Health Record Use With Quality of Care and Outcomes in Heart Failure: An Analysis of Get With The Guidelines—Heart Failure

Journal of the American Heart Association ◽

10.1161/jaha.117.008158 ◽

2018 ◽

Vol 7 (7) ◽

Cited By ~ 7

Author(s):

Senthil Selvaraj ◽

Gregg C. Fonarow ◽

Shubin Sheng ◽

Roland A. Matsouaka ◽

Adam D. DeVore ◽

...

Keyword(s):

Heart Failure ◽

Quality Of Care ◽

Electronic Health Record ◽

Health Record ◽

Electronic Health ◽

Get With The Guidelines

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Quality of Care for Patients With Acute Coronary Syndromes as a Function of Hospital Revascularization Capability: Insights From Get With The Guidelines-CAD

Clinical Cardiology ◽

10.1002/clc.22246 ◽

2014 ◽

Vol 37 (5) ◽

pp. 285-292 ◽

Cited By ~ 12

Author(s):

Arun K. Thukkani ◽

Gregg C. Fonarow ◽

Christopher P. Cannon ◽

Margueritte Cox ◽

Adrian F. Hernandez ◽

...

Keyword(s):

Quality Of Care ◽

Acute Coronary Syndromes ◽

Coronary Syndromes ◽

Get With The Guidelines

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National Surveillance of Stroke Quality of Care and Outcomes by Applying Post-Stratification Survey Weights on the Get With The Guidelines-Stroke Patient Registry

10.21203/rs.3.rs-104624/v1 ◽

2020 ◽

Author(s):

Boback Ziaeian ◽

Haolin Xu ◽

Roland A. Matsouaka ◽

Ying Xian ◽

Yosef Khan ◽

...

Keyword(s):

Ischemic Stroke ◽

Quality Of Care ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Patient Characteristics ◽

Care Quality ◽

Maximum Weight ◽

Get With The Guidelines ◽

Post Stratification

Abstract Background: The U.S. lacks a stroke surveillance system. This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality.Methods: Two statistical approaches were used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample. Post-stratification survey weights were estimated using a raking procedure and Bayesian interpolation methods. Weighting methods were adjusted to limit the dispersion of weights and make reasonable epidemiologic estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national estimates were reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated were patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results: A total of 1,388,296 acute ischemic strokes occurred between 2012 and 2014. Raking and Bayesian estimates of clinical data not recorded in administrative databases were estimated within 5% to 10% of the margins of expected values. Median weights for the raking method were 1.386 and the weights at the 99th percentile were 6.881 with a maximum weight of 30.775. Median Bayesian weights were 1.329 and the 99th percentile weights were 11.201 with a maximum weight of 515.689. Conclusions: Leveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. These methods may be applied to other diseases or settings to better monitor population health.

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Abstract TP284: Implementation of an Organized Stroke Care Program Reduced Door-to-needle Time in a Hospital in Mexico City

Stroke ◽

10.1161/str.48.suppl_1.tp284 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Juan Calleja ◽

Jesus Martinez ◽

Isabel Gutierrez

Keyword(s):

Care Program ◽

Quality Measures ◽

Stroke Care ◽

Number Of Patients ◽

Center Care ◽

Before And After ◽

Time Parameters ◽

Stroke Center ◽

Get With The Guidelines

Introduction: Reperfusion therapies are the optimal treatment for acute ischemic stroke (AIS). Their effectiveness is highly time-dependent. Worldwide, organized stroke care has shown to improve efficiency and quality of attention in stroke management. Neither reperfusion therapies or stroke center care have been widely implemented in Mexico. The objective of this study is to describe whether the implementation of a Stroke Care Program (ABC Stroke Center) improved time to treatment and adherence to Get With The Guidelines parameters on patients who underwent IV thrombolysis for AIS. Hypothesis: Implementation of an institutional Stroke Program lowers door-to-needle time (DNT) and improves adherence to stroke quality measures in patients treated with IV thrombolysis. Methods: The study included all patients with AIS diagnosis treated with IV thrombolysis between January 2010 and May 2016. We then compared patients admitted before and after June 2014 (start of the Stroke Program). Results: A total of 56 patients were included, 30 (53.6%) were admitted preintervention and 26 (46.4%) postintervention. All of them were treated with IV thrombolysis. All time parameters related to quality of attention were shorter in patients after the Stroke Program started. DNT was 21 minutes shorter in the Stroke Program group (mean 65 vs 86 min, p<0.03), and the number of patients within the DNT time goal of 60 minutes was larger postintervention (44.8 vs 29.6%, (95%CI 0.76 - 2.6, p=0.24)]. Adherence to stroke quality measures was more common in the Stroke Program group. Patients included after the start of the stroke program had a higher NIHSS score upon discharge. The probability of a good outcome (mRS<3) upon discharge was higher in the Stroke Program group (61.1% vs 31.4%) [RR = 1.9 (95%CI 1.17 - 3.38)]. Conclusions: Implementation of a Stroke Care program diminished DNT significantly and improved adherence to stroke quality measures. This may result on better outcomes for AIS patients.

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