title: Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry.
abstract: OBJECTIVE
  The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts (Mass), Michigan (Mich), and Ohio.
  
  
  METHODS
  Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective (Mass, Mich) or retrospective (Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome.
  
  
  RESULTS
  A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes (range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% (Mich) to 30.6% (Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% (Ga) and 8.5% (Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, <20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics.
  
  
  CONCLUSIONS
  A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the health care systems level, are needed to improve acute stroke care in the United States.
authors.affiliation: Michigan State University, East Lansing, USA. reevesm@msu.edu
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.forename: Shalini
authors.initials: S
authors.lastname: Arora
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
authors.forename: Michael
authors.initials: M
authors.lastname: Frankel
authors.forename: John P
authors.initials: JP
authors.lastname: Heinrich
authors.forename: Susan
authors.initials: S
authors.lastname: Hickenbottom
authors.forename: Herbert
authors.initials: H
authors.lastname: Karp
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: LaBresh
authors.forename: Ann
authors.initials: A
authors.lastname: Malarcher
authors.forename: G
authors.initials: G
authors.lastname: Mensah
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Lee
authors.initials: L
authors.lastname: Schwamm
authors.forename: Paul
authors.initials: P
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005845:Georgia; D006753:Hospital Records; D006801:Humans; D007262:Infusions, Intravenous; D002546:Ischemic Attack, Transient / Q000628:therapy; D008297:Male; D008404:Massachusetts; D008824:Michigan; D008875:Middle Aged; D009820:Ohio; D010865:Pilot Projects; D011446:Prospective Studies; D011786:Quality Control; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator