title: Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care.
abstract: In 2009, the Get With The Guidelines-Stroke (GWTG-Stroke) program offered additional recognition if hospitals performed well on certain stroke quality measures. We sought to determine whether quality of care for all hospitals participating in GWTG-Stroke improved with this expanded recognition program.
  
  
  
  We examined hospital-level performance on 6 quality of care (process) measures and 1 defect-free composite quality measure for stroke following expansion of the existing performance measure recognition program. Compliance with all measures improved following launch of the expanded program, and this rate increased significantly for all 9 measures. When evaluated as the relative rate of increase in use over time, process improvement slowed significantly (P<0.05) following launch of the program for 2 measures, and accelerated significantly for 1 measure. However, when evaluated as a gap in care, the decrease in the quality gap was greater following launch of the program for 5 of 6 (83%) measures. There was no evidence that other processes of stroke care suffered as the result of the increase in measures and expanded recognition program.
  
  
  
  While care for stroke continues to improve in this country, expanded hospital process performance recognition had mixed results in accelerating this improvement. However, the quality gap continues to shrink among those participating in provider performance programs.
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA heiden@stanford.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: University of Calgary, Alberta, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Smith
authors.affiliation: Michigan State University, Lansing, MI.
authors.forename: Mat
authors.initials: M
authors.lastname: Reeves
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: University of California Los Angeles, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D001363:Awards and Prizes; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D020521:Stroke / Q000628:therapy*
keywords: awards; health care quality assessment; health care quality indicators; hospital performance; performance measure; stroke