Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack

Schwamm, Lee H.; Fonarow, Gregg C.; Reeves, Mathew J.; Pan, Wenqin; Frankel, Michael; Smith, Eric E.; Ellrodt, Gray; Cannon, Christopher P.; Li, Liang; Peterson, Eric D.; LaBresh, Kenneth A.

doi:10.1161/circulationaha.108.783688

Cited by 513 publications

(559 citation statements)

References 29 publications

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“…Although several studies have reported on means of improving the timeliness of thrombolysis in acute stroke, [14][15][16][17][18]25 none has specifically focused on public safety net hospitals, which generally have less funding and treat more underor uninsured patients. As one of these hospitals, our institution treats a diverse and relatively socioeconomically disadvantaged population.…”

Section: Discussionmentioning

confidence: 99%

“…16 Other quality improvement initiatives, including the national "Get With The Guidelines-Stroke" initiative, have demonstrated similar success. 17,18 Interventions aimed at reducing time-to-thrombolysis are less well studied and may be more difficult to implement in public safety net hospitals. Such institutions face unique challenges related to reduced funding levels and care provision for larger proportions of socioeconomically disadvantaged patients, underinsured patients, and ethnic minorities.…”

Section: Introductionmentioning

confidence: 99%

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Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Threlkeld

Kozak

McCoy

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Background and Purpose: Shorter time-to-thrombolysis in acute ischemic stroke (AIS)is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital. Methods: All patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time.Here, we assess the relative impact of each intervention on DTN time. Results:The median DTN time pre-and postintervention decreased from 87 (interquartile range: 68-109) minutes to 49 (interquartile range: 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval: 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box. Conclusions: Multidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Threlkeld

Kozak

McCoy

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…Details of the design and conduct of the program have been previously described. 12 GWTG uses a web-based patient management tool (Outcome, Quintiles Company) to collect clinical data on consecutively admitted patients, to provide decision support, and to enable real-time online reporting features. After an initial pilot phase, the GWTG-Stroke Program was made available in April 2003 to any hospital in the United States.…”

Section: Methodsmentioning

confidence: 99%

“…Although the GWTG-Stroke program is overrepresented with larger academic teaching hospitals, the patient demographics and comorbidites are similar to those described in other stroke registries and administrative databases. 12 Outcome Sciences serves as the data collection and coordination center for GWTG. The Duke Clinical Research Institute serves as the data analysis center and has an agreement to analyze the aggregate deidentified data for research purposes.…”

Section: Methodsmentioning

confidence: 99%

Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke

Ovbiagele

Smith

Schwamm

et al. 2014

Circ: Cardiovascular Quality and Outcomes

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Background-The safety of intravenous thrombolysis in ischemic stroke (IS) patients with chronic kidney disease (CKD) is uncertain. We assessed whether CKD is associated with bleeding complications after intravenous tissue-type plasminogen activator administration to patients with IS. Methods and Results-Data were analyzed from 44 410 patients with IS treated with intravenous tissue-type plasminogen activator in the Get With The Guidelines-Stroke Program. Glomerular filtration rate based on admission serum creatinine was categorized as dichotomous (presence of CKD as <60) or as distinct categories: normal (≥90), mild (≥60-<90), moderate (≥30-< 60), severe (≥15-<30), and kidney failure (<15 or dialysis). Primary outcomes evaluated were symptomatic intracranial hemorrhage and serious systemic hemorrhage; secondary outcomes were in-hospital mortality, independent functional status. registry was analyzed to determine the association of CKD with key hemorrhagic outcomes after IV tPA for AIS.

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“…The American Heart Association (AHA) and American Stroke Association GWTG‐Stroke database data collection methods have been described previously 7, 8, 9, 10. In brief, participating hospitals used the AHA's Internet‐based Patient Management Tool (Quintiles) to enter data, receive decision support, and obtain feedback via on demand reports of performance on quality measures and recorded data from consecutive admissions for acute ischemic stroke.…”

Section: Methodsmentioning

confidence: 99%

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

Myint

Sheng

Xian

et al. 2018

JAHA

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BackgroundThe prognostic value of shock index (SI), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.Methods and ResultsWe examined the Get With The Guidelines–Stroke (GWTG‐Stroke) data to explore the usefulness of SI in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with SI of 0.5 to 0.7, patients with SI >0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [CI], 1.92–2.08) for in‐hospital mortality, 1.46 (95% CI, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95% CI, 1.47–1.54) for discharge destination other than home, 1.41 (95% CI, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95% CI, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when SI was additionally included in the models with or without blood pressure components. Every 0.1 increase in SI >0.5 was associated with significantly worse outcomes in linear spline models. The addition of SI to existing GWTG‐Stroke mortality prediction models without NIHSS demonstrated modest improvement, but little to no improvement was noted in models with NIHSS.Conclusions SI calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with NIHSS assessment.

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Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack

Abstract: Background-Adherence to evidence-based guidelines for treatment of stroke or transient ischemic attack is suboptimal.We sought to establish whether participation in Get With the Guidelines-Stroke was associated with improvements in adherence. Methods and Results-This

Cited by 513 publications

References 29 publications

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

Chronic Kidney Disease and Bleeding Complications After Intravenous Thrombolytic Therapy for Acute Ischemic Stroke

Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke

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