Abstract 120: Association Between Hospital Process Performance and Favorable Outcomes Among Patients With Acute Ischemic Stroke
Background: Guideline recommended care processes are increasing being employed to measure hospital quality of stroke care; however, data regarding the association between hospital process performance and outcomes are unclear in China. We use the China National Stroke Registry (CNSR) to evaluate whether hospital’s overall composite guideline adherence was associated with observed and risk-adjusted 3 months favorable outcomes rates after stroke.
Methods: An observational analysis of hospital care in 132 secondary and tertiary hospitals of 12 173 patients with acute ischemic stroke enrolled in the CNSR between 2007 and 2008. Thirteen performance measures including ten Get With The Guidelines-Stroke and 3 Chinese Neurology Association guideline-recommended interventions were adopted to measure hospital process performance for stroke care. The overall composite adherence rates of these performance measures were also calculated and divided into two levels according to median value. The relationship between hospital process performance for stroke care and three months favorable outcomes (defined as mRS 0-2), after stroke were analyzed using univariate analysis and generalized estimating equations.
Results: Overall, the 13 guideline-recommended performance measures were adhered to 69.3% if eligible instances. However, composite adherence performance varied widely (composite adherence scores from the lowest to highest hospital, 13.2% vs 90.2%). High composite guideline adherence rate was significantly associated with the 3-months favorable outcomes, with observed 3-months favorable outcomes increasing from 48.0% for the low adherence rate to 52.0% for the high adherence rate (OR 0.884, 95% CI 0.82-0.95, P=0.001). After adjustment of patients and hospitals’ characteristics, high composite adherence scores of hospitals had a positive impact on the 3-months favorable outcomes (B value 0.169 P=0.02).
Conclusions: A significant association between hospital performance for stroke care process and outcomes was found, supporting the use of broad, guideline-recommended performance metrics (including Get With The Guideline-Stroke) as a means of evaluating and helping improve hospital stroke care quality in China.
Author Disclosures: Z. Li: None. Y. Wang: None. X. Zhao: None. C. Wang: None. Y. Wang: None.
- © 2015 by American Heart Association, Inc.