Stroke hospitals more likely to provide guideline-recommended treatment

The American Heart Association/American Stroke Association's Get With The Guidelines-Stroke (GWTG-S) Performance Achievement Award (PAA) recognizes hospitals that meet specific criteria in following research-based guidelines for stroke care.

Primary Stroke Center (PSC) certification, a collaboration of the American Heart Association/ American Stroke Association and The Joint Commission, provides a framework for consistent clinical processes and program structure to help hospitals meet established standards of care.

"Primary stroke center certification is an important distinction for hospitals to achieve to meet minimum standards of stroke care," said Ralph Sacco, M.D., a past-president for the American Heart Association/American Stroke Association. "Certification and Get With The Guidelines-Stroke performance achievement measures complement one another, as both work for the same goal -- improving quality care for all stroke patients."

The researchers compared quality stroke care performance indicators for 400,707 acute ischemic stroke patients at 1,356 hospitals in 2010-12. They divided hospitals into those with: GWTG-Stroke PAA recognition and PSC certification; PAA recognition only; PSC certification only; and neither PAA recognition nor PSC certification.

Performance indicators include hospitals giving stroke patients a clot-busting medication within three hours of symptom onset, blood thinners within 48 hours of admission and prescriptions for high cholesterol and atrial fibrillation, if needed at discharge.

Researchers found:

• GWTG-Stroke PAA hospitals were more likely to follow the performance measures even if they didn't have PSC certification. Ischemic stroke patients were 3.23 times more likely to receive all performance measures of care at PAA-only hospitals compared to hospitals with neither quality indicator.
• The next highest level of hospital adherence to guideline-based stroke care was at PSC-only hospitals. Performance was lowest at hospitals with neither the recognition nor certification.
• Hospitals with GWTG-Stroke PAA recognition also provided therapy faster and more frequently than hospitals with only PSC certification. The proportion of patients receiving the clot-busting drug tPA (tissue plasminogen activator) within 60 minutes of hospital arrival was less frequent in PSC certified only hospitals as well as hospitals without recognition or certification.

"These findings suggest PSC certification programs should consider requiring hospitals to achieve a pre-specified level of achievement in stroke performance measures, adopting similar requirements to the GWTG-Stroke PAA recognition program," said Gregg C. Fonarow, M.D., the study's lead author and chairman of American Heart Association Hospital Accreditation Science Committee. "Alternatively, PSC certification programs could add a requirement for GWTG-Stroke participation with PAA recognition as part of the certification requirements."