Quality of care in women with ischemic stroke in the GWTG program.
OBJECTIVE
Prior studies have suggested worse poststroke outcomes in women. We sought to examine sex differences in quality of care (QOC) in the Get With The Guidelines-Stroke (GWTG-Stroke) program.


METHODS
We analyzed the relationships between sex and QOC as well as outcomes (in-hospital mortality and discharge home) using multivariable logistic regression models in 383 318 acute ischemic stroke admissions from 1139 hospitals that participated in the GWTG-Stroke program between 2003 to 2008. QOC was measured using 7 predefined performance measures and a defect-free care summary measure (defined as the proportion of patients who received all eligible interventions).


RESULTS
Compared to men, women were older and more likely to present by ambulance. They were also more likely to have a past medical history of atrial fibrillation or hypertension, and less likely to have a history of heart disease, dyslipidemia, or smoking. Although sex differences in individual performance measures were relatively modest they consistently identified women as being less likely to receive care compared to men. Overall, women received less defect-free care than men (66.3% versus 71.1%, adjusted odds ratio [aOR]=0.86; 95% confidence interval [CI] 0.85 to 0.87) and were less likely to be discharged home (41.0% versus 49.5%, aOR=0.84, 95% CI 0.83 to 0.85). Although crude mortality was higher in women (6.0% versus 5.2%), this difference was eliminated after risk adjustment (aOR=1.03, 95% CI 0.99 to 1.06).


CONCLUSIONS
Quality of care for women with ischemic stroke was lower than that for men, and women were less likely to be discharged home. Further study is warranted to identify the causes and consequences of these sex-based differences in care.
Reeves
Mathew J
MJ
Department of Epidemiology, Michigan State University, East Lansing, Michigan 48824, USA. reevesm@msu.edu
Fonarow
Gregg C
GC
Zhao
Xin
X
Smith
Eric E
EE
Schwamm
Lee H
LH
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality* / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012727:Sex Characteristics; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome