Abstract
BackgroundThere are several proven therapies for patients with ischemic stroke or transient ischemic attack (TIA), including prophylaxis of deep venous thrombosis (DVT) and initiation of antithrombotic medications within 48 h and at discharge. Stroke registries have been promoted as a means of increasing use of such interventions, which are currently underutilized.MethodsFrom 1999 through 2003, 86 U.S. hospitals participated in Ethos, a voluntary web-based acute stroke treatment registry. Detailed data were collected on all patients admitted with a diagnosis of TIA or ischemic stroke. Rates of optimal treatment (defined as either receipt or a valid contraindication) were examined within each hospital as a function of its length of time in registry. Generalized estimating equations were used to adjust for patient and hospital characteristics.ResultsA total of 16,301 patients were discharged with a diagnosis of stroke or TIA from 50 hospitals that participated for more than 1 year. Rates of optimal treatment during the first 3 months of participation were as follows: 92.5% for antithrombotic medication within 48 h, 84.6% for antithrombotic medications at discharge, and 77.1% for DVT prophylaxis. Rates for all treatments improved with duration of participation in the registry (p < 0.05), with the most dramatic improvements in the first year.ConclusionIn a large cohort of patients with stroke or TIA, three targeted quality-improvement measures improved among hospitals participating in a disease-specific registry. Although the changes could be attributed to interventions other than the registry, these findings demonstrate the potential for hospital-level interventions to improve care for patients with stroke and TIA.
Highlights
There are several proven therapies for patients with ischemic stroke or transient ischemic attack (TIA), including prophylaxis of deep venous thrombosis (DVT) and initiation of antithrombotic medications within 48 h and at discharge
Patients from 27 hospitals that had participated in the registry
For receipt of DVT prophylaxis and antithrombotics within 48 hours, no differences were observed between analyses that were inclusive or exclusive of patients who died in hospital
Summary
There are several proven therapies for patients with ischemic stroke or transient ischemic attack (TIA), including prophylaxis of deep venous thrombosis (DVT) and initiation of antithrombotic medications within 48 h and at discharge. There are several therapies for patients with ischemic stroke that have been proven in clinical trials and are recommended widely in consensus guidelines [1,2,3] These include prophylaxis for deep venous thrombosis (DVT) [4], antithrombotic therapy within 48 hours [5], and antithrombotic therapy at discharge [6]. Registries have been used as tools to define deficiencies and improve quality of care They are meant to enlighten practitioners and administrators about deficiencies, motivate change, and direct efforts [8]. When used as part of a continuous quality improvement program that includes institutional and practitioner-level feedback, registries have been demonstrated to improve care [9]
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