title: The Paul Coverdell National Acute Stroke Registry: initial results from four prototypes.
abstract: BACKGROUND
  This paper summarizes the experiences of the Paul Coverdell National Acute Stroke Registry first four prototype registries in Georgia (GA), Massachusetts (MA), Michigan (MI), and Ohio (OH), and includes information on their sampling design, case ascertainment, and data collection methods, as well as some key findings.
  
  
  METHODS
  Using a combination of different sampling methods, each prototype obtained a representative statewide sample of hospitals. Acute stroke admissions were identified through prospective (MA, MI) or retrospective (GA, OH) methods. A common set of case definitions and data elements were used by each registry. Weighted site-specific frequencies and 95% confidence intervals were generated for each outcome. A summary estimate, representing a weighted average of the four site-specific estimates, was also calculated.
  
  
  RESULTS
  Of the total 6867 admissions, 1487 (21.6%) were from the GA registry, 1206 (17.6%) from MA, 2566 (37.4%) from MI, and 1608 (23.4%) from the OH prototype. Just less than 60% of admissions were ischemic strokes (site-specific estimates ranged from 52% to 70%), with transient ischemic attack (18.5%) and intracerebral hemorrhage (8.8%) making up most of the remainder. Twenty-one percent of patients admitted were younger than 60 years of age, and 55.3% were women. The proportion of black subjects varied from 7.1% (MI) to 30.6% (GA). Twenty-three percent of admissions arrived at the emergency department within 3 hours of onset. Overall 4.5% of ischemic stroke admissions were treated with recombinant tissue plasminogen activator; site-specific treatment rates were 3.0% (GA), 3.2% (OH), 3.4% (MI), and 8.5% (MA). Only a small minority of treated patients (range, 10.8% [OH] to 19.6% [MI]) received recombinant tissue plasminogen activator within the recommended 1 hour door-to-needle time. A minority of eligible subjects were screened for dysphagia (45.4%), underwent lipid testing (33.6%), or received smoking-cessation counseling (21.4%). In contrast, compliance with antithrombotic treatments at discharge was high (91.5%).
  
  
  CONCLUSIONS
  A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the healthcare systems level, are needed to improve acute stroke care in the United States.
authors.affiliation: Department of Epidemiology, Michigan State University, East Lansing 48824, USA. reevesm@msu.edu
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
authors.forename: Michael
authors.initials: M
authors.lastname: Frankel
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: LaBresh
authors.forename: Lee
authors.initials: L
authors.lastname: Schwamm
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Paul
authors.initials: P
authors.lastname: Weiss
authors.forename: Irene
authors.initials: I
authors.lastname: Katzan
authors.forename: Shalini
authors.initials: S
authors.lastname: Arora
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: Ann
authors.initials: A
authors.lastname: Malarcher
authors.forename: George
authors.initials: G
authors.lastname: Mensah
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D003625:Data Collection; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008404:Massachusetts; D008485:Medical Audit; D008824:Michigan; D008875:Middle Aged; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012042:Registries; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D014481:United States