Abstract WP379: “Defect-Free” Stroke Care Improves Outcomes in Patients with Acute Ischemic Stroke

Abstract

Background: Studies showed that adherence to a standardized care process model (CPM) during hospitalization can improve clinical outcomes in numerous patient populations.AHA/ASA guidelines encourage this model to improve “Defect-Free” stroke care. It is unknown if “Defect-Free” care improves clinical outcomes in acute ischemic stroke (AIS) patients. In 2011, Intermountain Healthcare (IH) implemented a quality improvement initiative to improve compliance with 5 stroke care measures for AIS patients. Hypothesis: Implementation of a systematic quality improvement program will increase “Defect-Free” stroke care performance and improve clinical outcomes in AIS patients. Methods: A retrospective cohort study of AIS patients 18 years or older was conducted at 6 stroke receiving hospitals within IH. Defect-free care was defined as compliance with 5 care measures: ED arrival to head CT <25 minutes, ED arrival to rtPA <60 minutes, discharge on an anti-platelet, anticoagulation for patients with atrial fibrillation, and statin medication at discharge. All patients who met eligibility criteria for any measure were included. The primary outcome was hospital discharge disposition. Multivariate logistic regression (MLR) controlling for Charlson Comorbidity Index Score (CCIS) assessed the association of “Defect-Free” care with clinical outcomes. Results: Among 817 patients in the study, 707 received “Defect-free” care and 110 did not. The results indicates the compliance rate was increased from 78.1% in 2010 to 86.5% in 2011 (p<0.0001). Additionally, the percentage of patients discharged to home or rehabilitation facilities in “Defect-Free” care and “Non Defect-Free” care groups were 77.6% and 67.3%, respectively. MLR showed that patients who received “Defect-free" care were more likely to be discharged to home or a rehabilitation facility (OR=1.808, 95% CI: 1.155- 2.830) than those who did not get “Defect-free” care after adjusting for CCIS. Conclusion: Improving “Defect-free” stroke care by following a discreet CPM across an integrated healthcare system is achievable and results in improved clinical outcomes in AIS patients.