Dr. Gregg Fonarow
Timely stroke treatment is critical to ensuring good outcomes for patients. A new national study compared two programs designed to help hospitals adhere to nationally accepted standards and guideline recommendations for stroke treatment and found that hospitals participating in the Get With The Guidelines–Stroke program were more likely than Primary Stroke Center–certified hospitals to provide all the guideline-based measures of care for patients.
The study appears in the Oct. 14 issue of the Journal of the American Heart Association.
The American Heart Association/American Stroke Association's Get With The Guidelines–Stroke (GWTG–Stroke) Performance Achievement Award (PAA) recognizes hospitals that meet specific criteria in following research-based guidelines for stroke care.
Primary Stroke Center (PSC) certification, given by the American Heart Association/American Stroke Association and the Joint Commission, the entity that accredits U.S. hospitals, provides a framework for consistent clinical processes and program structure to help hospitals meet established standards of care.
The study authors, led by UCLA's Dr. Gregg Fonarow, compared quality stroke-care performance indicators for 400,707 acute ischemic patients at 1,356 hospitals between 2010 and 2012. These indicators included giving stroke patients the clot-busting drug tPA (tissue plasminogen activator) within three hours of stroke-symptom onset, blood thinners within 48 hours of admission, and prescriptions for high cholesterol and atrial fibrillation, if needed, at discharge.
They divided hospitals into those with (1) GWTG–Stroke PAA recognition and PSC certification, (2) PAA recognition only, (3) PSC certification only and (4) neither PAA recognition nor PSC certification.
- GWTG–Stroke PAA hospitals were more likely to follow the performance measures, even if they didn't have PSC certification. Ischemic stroke patients were 3.23 times more likely to receive all performance measures of care at hospitals that had only PAA recognition, compared with hospitals that had neither PAA recognition nor PSC certification.
- The next highest level of hospital adherence to guideline-based stroke care was seen at PSC–only hospitals. Performance was lowest at hospitals with neither PAA recognition nor PSC certification.
- GWTG–Stroke PAA hospitals provided therapy faster and more frequently than hospitals with only PSC certification. The proportion of patients receiving the clot-busting drug tPA within 60 minutes of hospital arrival was less frequent in PSC–only hospitals, as well as at hospitals without recognition or certification.
"These findings suggest PSC certification programs should consider requiring hospitals to achieve a pre-specified level of achievement in stroke performance measures, adopting similar requirements to the GWTG–Stroke PAA recognition program," said Fonarow the study's lead author, co-chief of the UCLA Division of Cardiology and chairman of American Heart Association Hospital Accreditation Science Committee. "Alternatively, PSC certification programs could add a requirement for GWTG–Stroke participation with PAA recognition as part of the certification requirements."
Fonarow noted that hospitals have come a long way in adhering to recommended guidelines for stroke. These quality improvement programs play a key role in helping hospitals meet national requirements to address patients' needs.
"Primary Stroke Center certification is an important distinction for hospitals to achieve to meet minimum standards of stroke care," said Dr. Ralph Sacco, a past-president for the American Heart Association/American Stroke Association. "Certification and Get With The Guidelines–Stroke performance achievement measures complement one another, as both work for the same goal — improving quality care for all stroke patients."
Co-authors of the study were Li Liang, Eric Smith, Mathew Reeves, Jeffrey Saver, Ying Xian, Adrian Hernandez, Eric Peterson and Lee Schwamm. Author disclosures are on the manuscript. The American Heart Association/American Stroke Association funded the study.