Abstract T P204: t-PA Utilization is Improving within Kaiser Permanente Southern California
Background and Objectives: Despite the efficacy of t-PA for acute ischemic stroke (IS), most patients do not receive the treatment. Due to aligned incentives, integrated health systems have shown to deliver higher-value care than their counterparts, therefore we sought to describe patterns of t-PA use within a large integrated health system (Kaiser Permanente Southern California). Our objectives were to describe the proportion of IS patients treated with t-PA, and to identify predictors associated with t-PA receipt.
Methods: This was a retrospective cohort analysis using existing structured data from an electronic health record encompassing 14 emergency departments between 2009-2013. We included patients 18 years or older with a primary or secondary ICD-9 diagnosis of acute IS. To focus on patients with acute presentations, we limited our sample to those who were imaged within 180 minutes of arrival. We built a multivariable regression model using random intercept for medical center to identify predictors of t-PA receipt.
Results: Of the 11,630 patients in our analysis, half were female (49.5%) and median age was 72 years (IQR 61-81). Four percent received t-PA during the study period (n=453), and treatment rate increased from 2.6% in 2009 to 6.4% in 2013 (p-value for trend <0.0001). Of the treated patients, median door-to-needle time was 73 minutes (IQR 55-103). Predictors of t-PA receipt are outlined in the table.
Conclusion: Between 2009-2013, 4% of all acute IS patients presenting to an integrated health system were treated with t-PA. Utilization of t-PA is improving over time, with age, gender, prior stroke, and ambulance arrival associated with t-PA treatment.
Author Disclosures: K. Sauser: None. N. Sangha: None. W.P. Neil: None. Z. Ajani: None. A.L. Sharp: None.
- © 2015 by American Heart Association, Inc.