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Kenneth A. LaBresh, MD; Mathew J. Reeves, PhD; Michael R. Frankel, MD; Dawn Albright, MS; Lee H. Schwamm, MD

Arch Intern Med. 2008;168(4):411-417.

Background  Adherence to evidence-based interventions for hospitalized patients who have experienced a stroke is suboptimal. We examined the association of process improvement and Internet-based data collection and decision support with stroke care.

Methods  A 1-year intervention study to assess performance measure adherence in hospitals using the "Get With The Guidelines–Stroke" program. The program included 18 410 patients with ischemic stroke or transient ischemic attack admitted to 99 volunteer community and teaching hospitals. Data from eligible patients in the preintervention baseline period were compared with data from 4 subsequent quarters for 12 acute care or secondary prevention measures and an all-or-none measure of care based on 7 prespecified measures.

Results  Significant improvements from baseline to the fourth quarter were seen in 11 of 13 measures: use of thrombolytic medications for patients with ischemic stroke presenting within 2 hours of onset, 23.5% vs 40.8% (P < .001); early use of antithrombotic medications, 88.2% vs 95.2% (P < .001); antithrombotic medications prescribed at discharge, 91.0% vs 97.9% (P < .001); anticoagulation agents for atrial fibrillation, 81.4% vs 96.5% (P < .001); smoking cessation counseling, 38.3% vs 54.5% (P < .001); lipid treatment for low-density lipoprotein levels 100 mg/dL or greater, 58.7% vs 77.0% (P < .001); diabetes mellitus treatment, 48.5% vs 83.5% (P = .001); and weight reduction counseling 32.5% vs 43.4% (P < .001). The all-or-none measure increased from 50.2% to 58.0% (P < .001). Complications from thrombolytic medications and prophylaxis for deep venous thrombosis did not change.

Conclusion  Statistically and clinically significant improvement in 11of 13 quality improvement measures for the treatment of patients hospitalized for cerebrovascular disease was seen in hospitals participating in the Get With The Guidelines program.

Author Affiliations: Masspro, Waltham, Massachusetts (Dr LaBresh and Ms Albright); Department of Epidemiology, Michigan State University, East Lansing (Dr Reeves); School of Medicine, Emory University, Atlanta, Georgia (Dr Frankel); and Stroke Service, Massachusetts General Hospital, Boston (Dr Schwamm).

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