Introduction: Measuring the quality of stroke care has become increasingly important, but real-world data are limited, especially because many hospitals do not track their own statistics. We sought to determine differences in quality-of-care metrics for ischemic stroke (IS) among non-stroke centers, primary stroke centers (PSC), and comprehensive stroke centers (CSC).
Methods: The Greater Cincinnati/Northern Kentucky (GCNK) Stroke Study measures temporal trends in the incidence of stroke in a biracial population of 1.3 million. Adult IS cases in 2010 from the GCNK region were ascertained from all local hospitals via ICD-9 codes 430-436 using retrospective chart review. Hospitals included 10 non-stroke centers, 2 PSCs, and 1 PSC that earned CSC status in 2013. Differences in IS patients’ demographics, medical histories, and quality measures were evaluated among hospital categories using chi-square, Fisher’s exact, and Kruskal-Wallis tests. Quality measures were matched to Get With The Guidelines-Stroke (GWTG-S) when possible, although data regarding the appropriateness for non-treatment were not available.
Results: In 2010, there were 1,981 IS patients in our population (55% female, 21% black) with a median age of 71 years. Of these, 83 were transferred to a different hospital type. There were significant differences in the demographics and medical histories of IS patients, as well as the majority of quality measures, with the CSC and PSCs demonstrating greater compliance with most metrics. (Table)
Conclusions: We found significant hospital-level differences in both premorbid patient characteristics and quality-of-care metrics depending on the hospital stroke certification status. To our knowledge, this is the first measurement of best-practice care specifically involving hospitals not participating in national quality improvement programs, such as GWTG-S. These differences may help inform quality improvement efforts across hospital types.