This hasn't changed my mind that GWTG is still wrong and could be replaced with something much better. GET WITH THE RESULTS. By not looking at and constantly measuring results hospitals can never consistently improve themselves. Guidelines allow slacking, results force hospitals to concentrate on improving them. Patients can understand results, they can't tell anything about guidelines except that they are used to confuse patients. Pay it forward and DEMAND results from your hospital. Don't be polite.
http://www.medpagetoday.com/CriticalCare/Strokes/57363?xid=nl_mpt_DHE_2016-04-15&eun=g424561d0r
Stroke patients treated at hospitals participating in the American
Heart Association's "Get With The Guidelines (GWTG)-Stroke" program were
more likely to be discharged to home and less likely to die than
patients treated at non-GWTG-Stroke hospitals, researchers reported.
Implementation of the program was associated with lower 30-day and
one-year mortality, and higher hospital-to-home discharge rates in a
study comparing these outcomes among stroke patients treated at 366
GWTG-Stroke hospitals and those treated at an equal number of hospitals
not participating in the program.
In
the period following program implementation, there was a 10% greater
relative increase in the rate of discharge to home and a 7% to 8%
greater relative increase in 30-day and 1-year mortality associated with
treatment at a GWTG-Stroke hospital, researchers Sarah Song, MD, of Rush University Medical Center, Chicago, and colleagues wrote in the journal Stroke, published online April 14.
No significant differences were seen, however, in 30-day and 1-year
rehospitalization rates between the two groups, and information on
functional outcomes was limited.
Since the initiation in 2003, more than 1,600 U.S. hospitals have become members of the GWTG-Stroke program, and more than two million patient records have been entered into the program's database.
Studies have consistently shown an increase in hospital discharge
with recommended medications and other quality metrics upon
implementation of GWTG-Stroke, but it has not been clear if this
improvement has led to improved clinical outcomes, the researchers
noted.
In an effort to better understand the impact of GWTG-Stroke on
outcomes, Song and colleagues reviewed Medicare data on approximately
174,000 acute ischemic stroke patients treated at GWTG-Stroke hospitals
(n=88,585) and nonprogram hospitals (n=85,401) between April 2003 and
December 2008.
The
researchers used a difference-in-difference design in an effort to
distinguish between program-associated changes in outcomes and
nonprogram related changes occurring during the study period.
Control group hospitals were identified from just over 3,000
non-GWTG-Stroke hospitals matched to participating hospitals on the
basis of several criteria, including hospital teaching status, hospital
region, annual ischemic stroke volume, and 1-year observed all-cause
mortality rate in the year before the GWTG-Stroke hospitals joined the
program.
The matching algorithm identified 366 GWTG-Stroke–adopting hospitals
that cared for 88,584 acute ischemic stroke admissions and 366
non–GWTG-Stroke hospitals that cared for 85,401 acute ischemic stroke
admissions.
Data collection began 18 months before participating hospitals joined
the program, and follow-up lasted for 18 months after the
implementation of the program. Four separate time periods were examined:
the "Pre" period (18 months to 6 months before GWTG-Stroke program
initiation), the "Run-Up" period (6 months to 1 day prior to joining),
the "Early" period (0 to 6 months after joining GWTG-Stroke), and the
"Sustained" period (6 months to 18 months after initiation).
The analysis revealed that compared with the Early period,
GWTG-Stroke hospitals had accelerated increases in discharge to home and
reduced mortality at 30 days and 1 year, and this accelerated reduction
in mortality at 1 year was sustained, with a trend toward sustained
accelerated increase in discharge to home.
A
significant study limitation cited by the researchers was the absence
of stroke severity measures and degree of residual disability among
stroke survivors in the CMS data set used in the study. Information on
adherence to guideline-recommended care after discharge was also not
available.
These and other limitations greatly limit the study's ability to
assess the impact of GWTG-Stroke participation on functional outcomes in
stroke survivors, neurologist Larry Goldstein, MD, of the University of Kentucky, Lexington, told MedPage Today.
He added that while hospital discharge to home may be considered a
surrogate measure of functional outcome, it is not a very specific one.
"This is one critical piece of information that they don't yet have.
Discharge to home does suggest some benefit, but we really can't say
that for sure."
Goldstein added that the study findings do appear to confirm an
improvement in guideline-based treatment in the months following
initiation of GWTG-Stroke.
"This suggests that putting the program into place and measuring outcomes is having an effect," he said.
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