Quality of Care in Women With Ischemic Stroke in the GWTG Program

Abstract

Prior studies have suggested worse poststroke outcomes in women. We sought to examine sex differences in quality of care (QOC) in the Get With The Guidelines-Stroke (GWTG-Stroke) program. We analyzed the relationships between sex and QOC as well as outcomes (in-hospital mortality and discharge home) using multivariable logistic regression models in 383 318 acute ischemic stroke admissions from 1139 hospitals that participated in the GWTG-Stroke program between 2003 to 2008. QOC was measured using 7 predefined performance measures and a defect-free care summary measure (defined as the proportion of patients who received all eligible interventions). Compared to men, women were older and more likely to present by ambulance. They were also more likely to have a past medical history of atrial fibrillation or hypertension, and less likely to have a history of heart disease, dyslipidemia, or smoking. Although sex differences in individual performance measures were relatively modest they consistently identified women as being less likely to receive care compared to men. Overall, women received less defect-free care than men (66.3% versus 71.1%, adjusted odds ratio [aOR]=0.86; 95% confidence interval [CI] 0.85 to 0.87) and were less likely to be discharged home (41.0% versus 49.5%, aOR=0.84, 95% CI 0.83 to 0.85). Although crude mortality was higher in women (6.0% versus 5.2%), this difference was eliminated after risk adjustment (aOR=1.03, 95% CI 0.99 to 1.06). Quality of care for women with ischemic stroke was lower than that for men, and women were less likely to be discharged home. Further study is warranted to identify the causes and consequences of these sex-based differences in care.