Acute ischemic stroke patients cared for by hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) had a better outcome than their counterparts in nonparticipating hospitals, according to a study from the Georgia Department of Public Health.
The study found that patients treated at non-GCASR facilities had a modest 14 percent increase in first-year risk of death. Several studies have shown that quality improvement efforts result in improved stroke patient care. This study, however, demonstrated that a state-based initiative based on the collaborative effort of professionals who are willing to share their expertise and exchange best practices results in tangible benefit to the community served.
The study analyzed data from 50,579 acute-ischemic-stroke patients admitted to 131 acute-care and critical-access hospitals in Georgia. Study researchers assessed the impact of participation in GCASR during 2006 to 2009.The average age for first stroke admission was 69 years.
GCASR-participating hospitals treated 56 percent of the ischemic stroke patients, and there were no statistical differences in age, hospital length of stay, proportion of various racial groups, or proportion of subjects with insurance coverage between patients treated at GCASR and non-GCASR hospitals. However, non-GCASR hospitals were more likely to see female stroke patients, have less than 100 beds, to be in nonmetropolitan areas, and record more stroke-related deaths at 30 and 365 days following stroke admissions. The overall mortality at 1 month and 1 year after the first admission were 8.1 percent and 18.5 percent, respectively.
Patients treated at non-GCASR facilities continued to have the risk of death throughout their follow-up time, indicating perhaps that the clinical care provided to patients at their first stroke episode influenced their risk of mortality in the subsequent years. Regardless of whether hospitals participated in the GCASR, patient outcomes throughout Georgia improved with time. Compared with patients who had an acute ischemic stroke in 2009, patients during 2006 through 2007 had a nine percent higher risk of dying during the first year after the index admission. Development of new treatment guidelines and implementation by providers may have contributed to the reduction in mortality.
The study appears in Preventing Chronic Disease