Abstract
BackgroundThe U.S. lacks a stroke surveillance system. This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality.MethodsTwo statistical approaches are used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample. Post-stratification survey weights are estimated using a raking procedure and Bayesian interpolation methods. Weighting methods are adjusted to limit the dispersion of weights and make reasonable epidemiologic estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national estimates are reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated are patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge.ResultsA total of 1,388,296 acute ischemic strokes occurred between 2012 and 2014. Raking and Bayesian estimates of clinical data not available in administrative data are estimated within 5 to 10% of margin for expected values. Median weight for the raking method is 1.386 and the weights at the 99th percentile is 6.881 with a maximum weight of 30.775. Median Bayesian weight is 1.329 and the 99th percentile weights is 11.201 with a maximum weight of 515.689.ConclusionsLeveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. These methods may be applied to other diseases or settings to better monitor population health.
Highlights
IntroductionThis study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality
The U.S lacks a stroke surveillance system
Full list of author information is available at the end of the article
Summary
This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality. The Institute of Medicine’s (IOM) report entitled A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases highlights the lack of systems to monitor the incidence and prevalence of preventable diseases at the national level [1]. The IOM’s report recommends that surveillance systems be created to track progress on cardiovascular burden and inform efforts to reduce disease burden. Since the IOM’s publication in 2011, robust disease surveillance systems for cardiovascular disease have not been developed in the U.S The glaring need to build such a surveillance system continues to be emphasized [2]. We sought to overcome these challenges by integrating two existing data sources for future epidemiologic and outcomes research work related to acute ischemic stroke
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