Introduction: Get With The Guidelines (GWTG)-Stroke is a stroke-care quality-improvement program implemented in 1,656 of 5,564 (30%) US hospitals; however, the assessment of the effectiveness of GWTG is limited by the lack of data from hospitals not participating in the program.
Methods: The REasons for Geographic And Racial Differences in Stroke (REGARDS) is a national population-based longitudinal cohort study of 30,239 black & white participants aged 45+ years. Participants with an incident stroke were hospitalized in their local hospital. The proportion of patients receiving each of 10 quality-care metrics was calculated among the stroke victims admitted to hospitals with and without GWTG-Stroke. Logistic regression was used to adjust for participant and hospital differences of those seen in GWTG/non-GWTG hospitals.
Results: Between 2003 and 2015, 207 of the 546 (38%) REGARDS participants suffering an ischemic stroke were treated in a hospital currently participating in the GWTG-Stroke program (the remainder in a non-GWTG hospital). Those hospitalized in a GWTG hospital were of similar age, race, sex, and risk factor profile as those in non-GWTG hospital (data not shown); however, fewer residents of the Stroke Belt were treated in a GWTG hospital (46.9% vs. 60.8%). Among the hospitals where participants were treated, the GWTG hospitals significantly larger (average 425 versus 289 beds) and were more likely to participate in GME resident training (59.9% versus 40.7%). After adjustment for these differences (see table), patients treated in GWTG hospitals were more likely to receive tPA (OR = 3.69), education on stroke risk factors and warning signs (OR = 1.52), swallowing evaluation (OR = 1.26), lipid profile evaluation (OR = 1.17), and evaluation by a neurologist (OR = 1.12).
Conclusions: The care of stroke patients admitted to hospitals participating in the GWTG-Stroke were more likely to meet important stroke quality care metrics.