Quality of care for in-hospital stroke: analysis of a statewide registry.
OBJECTIVE
approximately 4% to 17% of all adult strokes have onset in the hospital. Previous research indicates significant in-hospital evaluation delays and lower adherence to some measures of quality care compared to out-of-hospital strokes.


METHODS
quality of care for in-hospital ischemic strokes compared to stroke with out-of-hospital onset was examined using cohort analysis of a statewide stroke database maintained by the Colorado Stroke Alliance.


RESULTS
one-hundred sixteen in-hospital strokes were compared to 4946 out-of-hospital strokes. Patients with in-hospital strokes were significantly more likely to have history of coronary artery disease (36.7% vs 26.5%; P=0.02), and in-hospital strokes were more severe (NIHSS score 9.5 vs 7.0; P=0.01). Time to brain imaging was not significantly different (54 minutes vs 43 minutes; P=0.13) between groups. Patients with in-hospital stroke were significantly more likely to have documentation of stroke education (90.4% vs 73.1%; P=0.0002) and assessment for rehabilitation (67.7% vs 45.2%; P<0.0001). Total deficit-free care defined as adherence to all Get With the Guidelines Stroke (GWTG-Stroke) measures was better for in-hospital strokes compared to strokes in the community (52.8% vs 32.3%; P<0.0001).


CONCLUSIONS
adherence to GWTG-Stroke performance measures was better for in-hospital strokes in this statewide registry. Variability in reporting by participating hospitals suggests in-hospital strokes are under-recognized or under-reported. In-hospital stroke evaluation times remain more than twice the recommended benchmark of 25 minutes, representing an opportunity for process improvement.
Divisio of General Internal Medicine, University of Colorado Denver School of Medicine, Denver, CO, USA. Ethan.Cumbler@ucdenver.edu
Ethan
E
Cumbler
Paul
P
Murphy
William J
WJ
Jones
Heidi L
HL
Wald
Jean S
JS
Kutner
Don B
DB
Smith
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D003120:Colorado / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology