Published online before print May 12, 2005, doi: 10.1161/01.STR.0000165902.18021.5b
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(Stroke. 2005;36:1232.)
© 2005 American Heart Association, Inc.
Original Contributions |
Acute Stroke Care in the US
Results from 4 Pilot Prototypes of the Paul Coverdell National Acute Stroke Registry
*The Paul Coverdell Prototype Registries Writing Group includes Shalini Arora, MPH, Research Triangle Institute, Research Triangle Park, NC; Joseph P. Broderick, MD, University of Cincinnati, Ohio; Michael Frankel, MD, Emory University, Atlanta, Ga; John P. Heinrich, MPH, Research Triangle Institute, Research Triangle Park, NC; Susan Hickenbottom, MD, University of Michigan, Ann Arbor, Mich; Herbert Karp, MD, Georgia Medical Care Foundation, Atlanta, Ga; Kenneth A. LaBresh, MD, Massachusetts PRO, Boston, Mass; Ann Malarcher, PhD, Centers for Disease Control and Prevention, Atlanta, Ga; George Mensah, MD, Centers for Disease Control and Prevention, Atlanta, Ga; Charles J. Moomaw, University of Cincinnati, Ohio; Mathew J. Reeves, PhD, Michigan State University, East Lansing, Mich; Lee Schwamm, MD, Harvard University, Cambridge, Mass; Paul Weiss, Emory University, Atlanta, Ga.
Correspondence to Mathew J. Reeves, PhD, Department of Epidemiology, B 601 West Fee Hall, Michigan State University, East Lansing, MI 48824. E-mail reevesm{at}msu.edu
Background and Purpose— The Paul Coverdell National Acute Stroke Registry is being developed to improve the quality of acute stroke care. This article describes key features of acute stroke care from 4 prototype registries in Georgia (Ga), Massachusetts (Mass), Michigan (Mich), and Ohio.
Methods— Each prototype developed its own sampling scheme to obtain a representative sample of hospitals. Acute stroke admissions were identified using prospective (Mass, Mich) or retrospective (Ga, Ohio) methods. All prototypes used a common set of case definitions and data elements. Weighted site-specific frequencies were generated for each outcome.
Results— A total of 6867 admissions from 98 hospitals were included; the majority were ischemic strokes (range, 52% to 70%) with transient ischemic attack and intracerebral hemorrhage comprising the bulk of the remainder. Between 19% and 26% of admissions were younger than age 60 years, and between 52% and 58% were female. Black subjects varied from 7.1% (Mich) to 30.6% (Ga). Between 20% and 25% of admissions arrived at the emergency department within 3 hours of onset. Treatment with recombinant tissue plasminogen activator (rtPA) was administered to between 3.0% (Ga) and 8.5% (Mass) of ischemic stroke admissions. Of 118 subjects treated with intravenous rtPA, <20% received it within 60 minutes of arrival. Compliance with secondary prevention practices was poorest for smoking cessation counseling and best for antithrombotics.
Conclusions— A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the health care systems level, are needed to improve acute stroke care in the United States.
Key Words: health care • quality of healthcare • registries • stroke, acute
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