Abstract TP390: Patterns of Care, Variations and Temporal Trends in Stroke Care

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Abstract

Our aims were to describe temporal trends of the performances measures for ischemic stroke and to evaluate factors influencing stroke quality performances indicators.

Methods: We evaluated consecutive patients discharged with ischemic stroke at Hospital Israelita Albert Einstein from January 2009 to December 2013. Clinical characteristics and ten predefined performance measures selected by the Get with the Guidelines (GWTG) stroke program as targets for stroke quality improvement were evaluated.

Results: We evaluated 551 patients, the median age was 77.0 years old [64.0-84.0], 58.4% were man and the median time from symptom onset to hospital admission was 345.0 minutes [104.5-1417.5]. The median length of stay was 8.0 days [4.0-14.0], 17.1% received thrombolytic treatment. A good outcome at discharge (modified Rankin scale <3) was observed in 67.6% of the patients, 7.9% of the patients had died. The quality indicators that were different between years were: use of antithrombotic therapy at discharge, cholesterol-lowering therapy, smoking cessation counseling and stroke education. In the univariate analysis being discharged in a Joint Commission visit year (OR 1.84 [1.29-2.61], p<0.01), female sex (OR 0.68 CI [0.48-0.96], p=0.03), dyslipidemia (OR 1.95 [1.33-2.88], p<0.01) and receiving thrombolytic treatment (OR 1.81 [1.08-3.02], CI p=0.02) were found to be associated with a perfect care index of 85% or higher. After multivariate adjustment, only thrombolytic treatment OR 2.06 CI 95%[1.21-3.51] p<0.01, dyslipidemia OR 2.03 [1.36-3.02] p<0.01 and discharge in a Joint Commission’s visit year OR 1.8 CI 95%[1.29-2.65] p<0.01 remained in the model as predictors of higher perfect care index.

Conclusion: Clinical characteristics like dyslipidemia and being treated with thrombolysis and being admitted in a Joint Commission visit year seems to influence adhesion to quality performance indicators in our Stroke Center. A more continuous evaluation of Stroke Centers by Joint Commission instead of pre specified evaluation visits seems to be justified.

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