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. 2018 Nov 1;75(11):1331-1337.
doi: 10.1001/jamaneurol.2018.2101.

Participation in Get With The Guidelines-Stroke and Its Association With Quality of Care for Stroke

George Howard  1 , Lee H Schwamm  2 , John P Donnelly  3 , Virginia J Howard  3 , Adam Jasne  4 , Eric E Smith  5 , J David Rhodes  1 , Brett M Kissela  4 , Gregg C Fonarow  6   7 , Dawn O Kleindorfer  4 , Karen C Albright  7   8
Affiliations

Participation in Get With The Guidelines-Stroke and Its Association With Quality of Care for Stroke

George Howard et al. JAMA Neurol. .

Abstract

Importance: Get With The Guidelines-Stroke (GWTG-Stroke) is an American Heart Association/American Stroke Association stroke-care quality-improvement program; however, to our knowledge, there has not been a direct comparison of the quality of care between patients hospitalized at participating hospitals and those at nonparticipating hospitals.

Objective: To contrast quality of stroke care measures for patients admitted to hospitals participating and not participating in GWTG-Stroke.

Design, setting, and participants: Subpopulation of 546 participants with ischemic stroke occurring during a 9-year follow-up of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a population-based cohort study of 30 239 randomly selected black and white participants 45 years and older recruited between 2003 and 2007. Of those with stroke, 207 (36%) were treated in a hospital participating in GWTG-Stroke and 339 in a nonparticipating hospital. Data were analyzed between July 29, 2017, and April 17, 2018.

Main outcomes and measures: Quality of care measures including use of tissue plasminogen activator, performance of swallowing evaluation, antithrombotic use in first 48 hours, lipid profile assessment, discharge receiving antithrombotic therapy, discharge receiving a statin, neurologist evaluation, providing weight loss and exercise counseling, education on stroke risk factors and warning signs, and assessment for rehabilitation.

Results: Participants treated at participating hospitals had a mean (SD) age of 74 (8) years and 100 of 207 were men (48%), while those seen at nonparticipating hospitals had a mean (SD) age of 73 (9) years, and 161 of 339 were men (48%). Those seen in participating hospitals were more likely to receive 5 of 10 evidence-based interventions recommended for patients hospitalized with ischemic stroke, including receiving tissue plasminogen activator (RR, 3.74; 95% CI, 1.65-8.50), education on risk factors (RR, 1.54; 95% CI, 1.16-2.05), having an evaluation for swallowing (RR, 1.25; 95% CI, 1.04-1.50), a lipid evaluation (RR, 1.18; 95% CI, 1.05-1.32), and an evaluation by a neurologist (RR, 1.12; 95% CI, 1.05-1.20). Those seen in participating hospitals received a mean of 5.4 (95% CI, 5.2-5.6) interventions compared with 4.8 (95% CI, 4.6-5.0) in nonparticipating hospitals (P < .001).

Conclusions and relevance: These data collected independently of the GWTG-Stroke program document improved stroke care for patients with ischemic stroke hospitalized at participating hospitals.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schwamm reports being the principal investigator of an investigator-initiated study of extended-window intravenous thrombolysis funded by the National Institutes of Neurological Disorders and Stroke (http://clinicaltrials.gov/show/NCT01282242), for which Genentech provides alteplase free of charge to Massachusetts General Hospital as well as supplemental per-patient payments to participating sites; serving as chair of the American Heart Association/American Stroke Association Get With The Guidelines (GWTG) stroke clinical work group and hospital accreditation Science Committee; serving as a stroke systems consultant to the Massachusetts Department of Public Health; and serving as a scientific consultant regarding trial design and conduct to Penumbra (data and safety monitoring committee, Separator 3D and MIND trial) and Medtronic (Victory AF and Stroke AF trials). Dr Smith discloses that he is a member of the GWTG steering committee. Dr Fonarow reports serving on the GWTG steering committee, receiving grant funding from the Patient Centered Outcome Research Institute; and being an employee of the University of California, which has a patent on an endovascular therapy. Dr Jasne was supported by National Institutes of Health training grant T32 NS47996-12. No other disclosures are reported.

Figures

Figure.
Figure.. Residential Location of Reasons for Geographic and Racial Differences in Stroke Participants in Analysis
Orange represents admission to a Get With The Guidelines–Stroke (GWTG-Stroke) hospital and blue represents admission to a non–GWTG-Stroke hospital. A large number of admissions in major urban centers are overlaid.
See this image and copyright information in PMC

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References

    1. LaBresh KA, Gliklich R, Liljestrand J, Peto R, Ellrodt AG. Using “get with the guidelines” to improve cardiovascular secondary prevention. Jt Comm J Qual Saf. 2003;29(10):539-550. - PubMed
    1. LaBresh KA, Reeves MJ, Frankel MR, Albright D, Schwamm LH. Hospital treatment of patients with ischemic stroke or transient ischemic attack using the “Get With The Guidelines” program. Arch Intern Med. 2008;168(4):411-417. - PubMed
    1. American Heart Association/American Stroke Association Get With the Guidelines-Stroke: patient management tool. http://www.heart.org/HEARTORG/Professional/GetWithTheGuidelines/GetWithT.... Accessed October 30, 2017.
    1. Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke Vasc Neurol. 2017;2(2):94-105. - PMC - PubMed
    1. Schwamm LH, Fonarow GC, Reeves MJ, et al. . Get With the Guidelines-Stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2009;119(1):107-115. - PubMed

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