title: Duration of hospital participation in a nationwide stroke registry is associated with improved quality of care.
abstract: BACKGROUND
  There are several proven therapies for patients with ischemic stroke or transient ischemic attack (TIA), including prophylaxis of deep venous thrombosis (DVT) and initiation of antithrombotic medications within 48 h and at discharge. Stroke registries have been promoted as a means of increasing use of such interventions, which are currently underutilized.
  
  
  METHODS
  From 1999 through 2003, 86 U.S. hospitals participated in Ethos, a voluntary web-based acute stroke treatment registry. Detailed data were collected on all patients admitted with a diagnosis of TIA or ischemic stroke. Rates of optimal treatment (defined as either receipt or a valid contraindication) were examined within each hospital as a function of its length of time in registry. Generalized estimating equations were used to adjust for patient and hospital characteristics.
  
  
  RESULTS
  A total of 16,301 patients were discharged with a diagnosis of stroke or TIA from 50 hospitals that participated for more than 1 year. Rates of optimal treatment during the first 3 months of participation were as follows: 92.5% for antithrombotic medication within 48 h, 84.6% for antithrombotic medications at discharge, and 77.1% for DVT prophylaxis. Rates for all treatments improved with duration of participation in the registry (p < 0.05), with the most dramatic improvements in the first year.
  
  
  CONCLUSIONS
  In a large cohort of patients with stroke or TIA, three targeted quality-improvement measures improved among hospitals participating in a disease-specific registry. Although the changes could be attributed to interventions other than the registry, these findings demonstrate the potential for hospital-level interventions to improve care for patients with stroke and TIA.
authors.affiliation: Department of Neurology, Box 0114, University of California San Francisco, 505 Parnassus Ave., M-798, San Francisco, CA 94143-0114, USA. nancy.hills@ucsfmedctr.org
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Hills
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D015331:Cohort Studies; D042241:Early Diagnosis; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000379:methods; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries / Q000592:standards / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D005343:Fibrinolytic Agents