Duration of hospital participation in a nationwide stroke registry is associated with improved quality of care.
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.
Hills
Nancy K
NK
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
Johnston
S Claiborne
SC
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
D005343:Fibrinolytic Agents