title: Administrative data linkage to evaluate a quality improvement program in acute stroke care, Georgia, 2006-2009.
abstract: BACKGROUND
  Tracking the vital status of stroke patients through death data is one approach to assessing the impact of quality improvement in stroke care. We assessed the feasibility of linking Georgia hospital discharge data with mortality data to evaluate the effect of participation in the Georgia Coverdell Acute Stroke Registry on survival rates among acute ischemic stroke patients.
  
  
  METHODS
  Multistage probabilistic matching, using a fine-grained record integration and linkage software program and combinations of key variables, was used to link Georgia hospital discharge data for 2005 through 2009 with mortality data for 2006 through 2010. Data from patients admitted with principal diagnoses of acute ischemic stroke were analyzed by using the extended Cox proportional hazard model. The survival times of patients cared for by hospitals participating in the stroke registry and of those treated at nonparticipating hospitals were compared.
  
  
  RESULTS
  Average age of the 50,579 patients analyzed was 69 years, and 56% of patients were treated in Georgia Coverdell Acute Stroke Registry hospitals. Thirty-day and 365-day mortality after first admission for stroke were 8.1% and 18.5%, respectively. Patients treated at nonparticipating facilities had a hazard ratio for death of 1.14 (95% confidence interval, 1.03-1.26; P = .01) after the first week of admission compared with patients cared for by hospitals participating in the registry.
  
  
  CONCLUSIONS
  Hospital discharge data can be linked with death data to assess the impact of clinical-level or community-level chronic disease control initiatives. Hospitals need to undertake quality improvement activities for a better patient outcome.
authors.affiliation: Georgia Department of Public Health, 2 Peachtree St, NW, Suite 14-277, Atlanta, GA 30303-3142. E-mail: Moges.Ido@dph.ga.gov.
authors.forename: Moges Seyoum
authors.initials: MS
authors.lastname: Ido
authors.affiliation: Georgia Department of Public Health, Atlanta, Georgia.
authors.forename: Rana
authors.initials: R
authors.lastname: Bayakly
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Michael
authors.initials: M
authors.lastname: Frankel
authors.affiliation: Georgia State University, Atlanta, Georgia.
authors.forename: Rodney
authors.initials: R
authors.lastname: Lyn
authors.affiliation: Georgia State University, Atlanta, Georgia.
authors.forename: Ike S
authors.initials: IS
authors.lastname: Okosun
mesh_terms: D000208:Acute Disease; D000368:Aged; D003625:Data Collection / Q000379:methods*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends