Influence of stroke subtype on quality of care in the Get With The Guidelines-Stroke Program.
OBJECTIVE
Little is known about in-hospital care for hemorrhagic stroke. We examined quality of care in intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) admissions in the national Get With The Guidelines-Stroke (GWTG-Stroke) database, and compared them to ischemic stroke (IS) or TIA admissions.


METHODS
Between April 1, 2003, and December 30, 2007, 905 hospitals contributed 479,284 consecutive stroke and TIA admissions. The proportions receiving each quality of care measure were calculated by dividing the total number of patients receiving the intervention by the total number of patients eligible for the intervention, excluding ineligible patients or those with contraindications to treatment. Logistic regression models were used to determine associations between measure compliance and stroke subtype, controlling for patient and hospital characteristics.


RESULTS
Stroke subtypes were 61.7% IS, 23.8% TIA, 11.1% ICH, and 3.5% SAH. Performance on care measures was generally lower in ICH and SAH compared to IS/TIA, including guideline-recommended measures for deep venous thrombosis (DVT) prevention (for ICH) and smoking cessation (for SAH) (multivariable-adjusted p < 0.001 for all comparisons). Exceptions were that ICH patients were more likely than IS/TIA to have door-to-CT times <25 minutes (multivariable-adjusted p < 0.001) and to undergo dysphagia screening (multivariable-adjusted p < 0.001). Time spent in the GWTG-Stroke program was associated with improvements in many measures of care for ICH and SAH patients, including DVT prevention and smoking cessation therapy (multivariable-adjusted p < 0.001).


CONCLUSIONS
Many hospital-based acute care and prevention measures are underutilized in intracerebral hemorrhage and subarachnoid hemorrhage compared to ischemic stroke /TIA. Duration of Get With The Guidelines-Stroke participation is associated with improving quality of care for hemorrhagic stroke.
Smith
E E
EE
Calgery Stroke Program, Hotchkiss Brain Institute, University of Calgary, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB, Canada T2N 2T9. eesmith@ucalgary.ca
Liang
L
L
Hernandez
A
A
Reeves
M J
MJ
Cannon
C P
CP
Fonarow
G C
GC
Schwamm
L H
LH
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000451:nursing / Q000517:prevention & control / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data; D020521:Stroke / Q000145:classification / Q000517:prevention & control / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000451:nursing / Q000517:prevention & control / Q000628:therapy; D014481:United States; D020246:Venous Thrombosis / Q000451:nursing / Q000517:prevention & control / Q000628:therapy