Abstract 3029: Improved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke During Initial Implementation of the Get With The Guidelines-Stroke (GWTG-S) Program 2003-2008

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Sarah Song ◽  
Gregg C Fonarow ◽  
Wendy Pan ◽  
DaiWai M Olson ◽  
Adrian F Hernandez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Early Period ◽  
Stroke Care ◽  
Medicare Beneficiaries ◽  
Improvement Programs ◽  
Time Periods ◽  
Get With The Guidelines

Background: The first decade of the 21st century saw several changes in acute ischemic stroke care, including greater use of statins, tobacco cessation counseling, IV rt-PA, formally organized stroke centers, and national performance improvement programs. Changes in clinical outcomes from acute ischemic stroke during this period have not been fully delineated. Methods: We examined the national Medicare dataset to analyze clinical outcomes of ischemic stroke patients at hospitals joining Get With The Guidelines-Stroke (GWTG-Stroke) from April 1, 2003 to December 12, 2008. We designated three time periods of interest: 1) pre-period (6 months prior to GWTG-S participation, 2) early period (first 6 months of GWTG-Stroke participation), and 3) late period (6 to 18 months after GWTG-Stroke implementation). Clinical outcomes analyzed included discharge to home; inpatient, 30 day, and 1 year mortality; and 30 day and 1 year rehospitalization for stroke, cardiovascular event, and all cause. Results: 139,293 patients from 725 sites were included in the analysis. Mean age was 79.5 years, 41% male, 84% white. Patient demographics were similar across the three time periods, with minimal differences in comorbidities (e.g. diabetes, renal disease). Statistically significant changes between pre and late periods included: lower 30 day mortality (15.3% vs. 13.0%, p<.0001), lower 1 year mortality (28.0% vs 25.5%, p<.0001), lower stroke/TIA rehospitalization at 30 days (3.1% vs. 2.4%, p<.0001) and 1 year (9.2% vs. 8.7%, p<.002), lower rehospitalization for cardiovascular event at 30 days (2.9% vs. 2.3%, p<.0001) and 1 year (15.9% vs. 13.5%, p<.0001), and lower all cause rehospitalization at 30 days (17.4% vs. 15.1%, p<.0001) and 1 year (55.8% vs. 53.0%, p<.0001). Intermediate changes were seen during the early period. Rates of inpatient mortality and discharge to home did not change. Conclusions: During the first 2 years of participation, clinical outcomes for Medicare beneficiaries with acute ischemic stroke among hospitals joining GWTG-Stroke improved substantially, with 15% lower 30 day mortality rates and 24% lower 30 day rehospitalization rates for stroke or TIA. Further study is planned to determine if similar improvements in outcomes occurred at non-participating hospitals during this time frame.

Abstract 8: Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Sarah Song ◽  
Gregg Fonarow ◽  
Wenqin Pan ◽  
DaiWai Olson ◽  
Adrian F Hernandez ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Early Period ◽  
Quality Improvement Program ◽  
Administrative Claims ◽  
Improvement Program ◽  
All Cause Mortality ◽  
Before And After ◽  
Get With The Guidelines

Background: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. While studies have shown a beneficial effect of hospital participation in GWTG-Stroke upon processes of care, whether there are associated improvements in clinical outcomes has not been previously investigated. Methods: From among all acute care US hospitals, we matched 366 hospitals that joined the GWTG-Stroke program between April 2004 and December 2007, with 366 hospitals that did not. Matching was based on ischemic stroke case volume, calendar year, baseline hospital post-stroke 1-year all-cause mortality rates, teaching status, and geographic region. Outcomes of all acute ischemic stroke (AIS) patients admitted to the study hospitals were abstracted from the CMS administrative claims database (65 years and older). Outcomes at matched hospitals were compared in the PRE-GWTG-Stroke period (-540 to -181 days before program launch), RUN-UP period (-180- to -1 day), EARLY period (0 to 180 days) and SUSTAINED period (181 to 540 days). Additional analysis was performed of the entire BEFORE (-540 to -1 days) and AFTER periods (0 to 540 days). The main analytical approach was stratified Cox proportional hazard modeling, with matched site ID at stratum. We adjusted for patient characteristics (age, gender, race, medical history) and hospital characteristics (rural vs. urban, # beds, annual IS discharges.) Results: The study analyzed 88,584 AIS admissions at the 366 GWTG-Stroke hospitals and 85,401 admissions at the 366 matched non-GWTG-Stroke hospitals. In adjusted analysis comparing BEFORE and AFTER periods, GWTG-Stroke hospitals achieved reduced 30 day mortality (30M - HR 0.911, p<0.0001), reduced 1 year mortality (1YM - HR 0.902, p<0.0001), reduced 30 day all-cause rehospitalization (HR 0.956, p=0.013), reduced 30 day stroke rehospitalization (HR 0.927, p=0.038), and reduced 1 year all-cause rehospitalization (HR 0.972, p=0.007). Conversely, matched, non-GWTG-Stroke hospitals showed only reduced 30M (HR 0.954, p=0.010) between the BEFORE and AFTER periods. Comparing the degree of change at GWTG-Stroke with non-GWTG Stroke hospitals, there were greater improvements in discharge to home (DCH), 30M, and 1YM at GWTG-Stroke hospitals in each of the intervention periods: EARLY: DCH, HR 1.090, p<0.0001; 30M, HR 0.894, p=0.0006; 1YM, HR 0.889, p<0.0001; SUSTAINED: DCH, HR 1.097, p<0.0001; 30M, HR 0.934, p=0.004; 1YM, HR 0.918, p<0.0001. Conclusions: Hospitals joining the GWTG-Stroke quality improvement program between 2004-2008 achieved significantly greater improvement in stroke patient outcomes than matched hospitals not joining the program, with lower all-cause mortality at 30 days and 1 year and higher rates of discharge directly to home.

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

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.

Abstract 12: National Surveillance of Stroke Quality of Care and Outcomes Using Post-stratification Survey Weights on the Get With the Guidelines-stroke Patient Registry

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Boback Ziaeian ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Ying Xian ◽  
Yosef Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Stroke Patient ◽  
Population Estimates ◽  
Maximum Weight ◽  
Get With The Guidelines ◽  
Post Stratification

Background: The U.S. lacks an appropriate stroke surveillance system. This study developed and validated post-stratification weights for an existing stroke patient registry to represent the entire U.S. population across the nine U.S. Census divisions. 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 to model the burden of acute ischemic stroke. Post-stratification survey weights were estimated using a raking procedure and Bayesian interpolation methods. Both strategies for developing weights were compared. Weighting methods were adjusted to limit dispersion of weights and make reasonable national estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national population estimates were reported between the two post-stratification methods. Color treemaps were used to visualize the distribution of post-stratification weights across relevant sub-populations. Primary measures evaluated were patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results: There were a total of 1,388,296 acute ischemic strokes 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 reference values. Median weights for the raking method were 1.366 and the weights at the 99 th percentile were 6.881 with a maximum weight of 30.775. Median Bayesian weights were 1.329 and the 99 th 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. Post-stratification weighting may be used as a basis for more advanced modeling relevant to understanding the burden of acute ischemic stroke and the quality of care delivered in U.S. hospitals. These methods may be applied to other diseases or settings to better monitor population health.

scholarly journals Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Presentation, Treatment, and Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Timothy G. White ◽  
Gabriela Martinez ◽  
Jason Wang ◽  
Michele Gribko ◽  
Artem Boltyenkov ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Volume ◽  
Acute Ischemic Stroke ◽  
World Health ◽  
Global Pandemic ◽  
Significant Difference ◽  
Time Periods ◽  
Health Organization ◽  
Get With The Guidelines ◽  
The Impact

Introduction. The World Health Organization declared COVID-19 a global pandemic last year. While a clear impact of COVID-19 on the declining stroke volume has been reported, its overall impact on stroke presentation and clinical outcomes has not been established. The purpose of this study was to assess the impact of COVID-19 on acute ischemic stroke volume, presentation, treatment, and outcomes at comprehensive stroke centers. Methods. A retrospective review of patients with a discharge diagnosis of acute ischemic stroke from the Get With The Guidelines database was performed from January 1, 2019, to July 1, 2020. The following time periods were defined: Pre-COVID (January/February), Peak-COVID (March/April), and Post-COVID (May/June). Bivariate analyses were performed comparing the 2020 and 2019 time periods to determine differences in stroke volume, presentation, treatment, and outcomes. Results. Stroke volumes were significantly lower during the Peak-COVID period in 2020 compared to that in 2019, with an absolute decline of 49.5% ( P < 0.001 ). Patients were more likely to present after 24 hours from last known well during the 2020 Peak-COVID period ( P = 0.03 ). However, there was not a significant difference in the rate of treatment with either the tissue plasminogen activator (tPA) or mechanical thrombectomy during the Peak-COVID period. Interestingly, relative treatment rates increased during the 2020 Post-COVID period to 11.4% ( P = 0.01 ). Conclusions. The overall ischemic stroke volume decreased during the pandemic, and patients had a tendency to present later, beyond eligible treatment windows. However, rates of treatment, patient demographics, and stroke outcomes did not significantly change when compared to the prior year.

scholarly journals National surveillance of stroke quality of care and outcomes by applying post-stratification survey weights on the Get With The Guidelines-Stroke patient registry

2021 ◽  
Vol 21 (1) ◽  
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 are 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 are estimated using a raking procedure and Bayesian interpolation methods. Weighting methods are 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 are reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated are 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 available in administrative data are estimated within 5 to 10% of margin for expected values. Median weight for the raking method is 1.386 and the weights at the 99th percentile is 6.881 with a maximum weight of 30.775. Median Bayesian weight is 1.329 and the 99th percentile weights is 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.

scholarly journals Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (5) ◽  
pp. 1294-1302 ◽  
Author(s):  
Sarah Song ◽  
Gregg C. Fonarow ◽  
DaiWai M. Olson ◽  
Li Liang ◽  
Phillip J. Schulte ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Program Participation ◽  
Medicare Beneficiaries ◽  
Get With The Guidelines
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