Background: Prior studies have demonstrated that women and black patients with acute ischemic stroke were significantly less likely to be treated with intravenous tPA with door-to-needle (DTN) times of ≤60 minutes. Whether stroke quality improvement programs can impact care to a similar degree among sex and race/ethnic groups has not been well studied. This study aims to assess sex and race/ethnicity specific improvements in DTN times before and after the launch of Target: Stroke Phase I in 2010.
Methods: Target: Stroke identified and disseminated 10 best practice strategies, provided clinical decision support tools, and set hospital recognition goals. Rates of DTN times ≤60 minutes and cumulative improvements pre- 2003-2009 were compared to post-Target Stroke 2010-2013 for sex and race/ethnic groups. Data were adjusted for patient and hospital characteristics.
Results: There were 71,169 intravenous tPA treated patients (27,303 pre-; 43,866 post-Target Stroke) from 1030 GWTG-Stroke hospitals. Patients were median age 72, 50.1% women, and 72.0% white, 13.8% black, and 6.6% Hispanic. Overall, patients with DTN times ≤ 60 minutes increased from 26.5% (95% CI 26.0-27.1%) pre-intervention to 41.3% (95% CI 40.8-41.7%) post-intervention (P<.0001), reaching 51.0% in 2013. There were no significant differences in cumulative improvements in DTN times by sex and race/ethnic groups, even after adjustment for other patient and hospital characteristics (Table).
Conclusions: The implementation of Target: Stroke was associated with equitable improvements in DTN times for men and women and for black, white, and Hispanic ischemic stroke patients. These findings highlight the role that quality improvement programs can play in providing more timely and effective stroke care for all patients, irrespective of sex and race/ethnicity.