Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke

This is completely and totally fucking worthless. By measuring guidelines instead of results you are insuring that improvements will not occur on a regular basis. 
http://stroke.ahajournals.org/content/early/2016/04/13/STROKEAHA.115.011874.abstract

1. Sarah Song, MD, MPH,
2. Gregg C. Fonarow, MD,
3. DaiWai M. Olson, PhD, RN,
4. Li Liang, PhD,
5. Phillip J. Schulte, PhD,
6. Adrian F. Hernandez, MD, MS,
7. Eric D. Peterson, MD, MPH,
8. Mathew J. Reeves, PhD,
9. Eric E. Smith, MD, MPH,
10. Lee H. Schwamm, MD and
11. Jeffrey L. Saver, MD

+ Author Affiliations

1. From the Department of Neurology, Rush University Medical Center, Chicago, IL (S.S.); Departments of Cardiology (G.C.F.) and Neurology (J.L.S.), University of California, Los Angeles; Department of Neurology, University of Texas-Southwestern, Dallas (D.M.O.); Departments of Biostatistics and Bioinformatics (L.L., P.J.S.) and Cardiology (A.F.H., E.D.P.), Duke University, Durham, NC; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); and Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).

1. Correspondence to Sarah Song, MD, MPH, Department of Neurology, Rush University Medical Center, 1725 W Harrison St, Suite 1121, Chicago, IL 60612. E-mail sarah_song@rush.edu

Abstract

Background and Purpose—Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. Although studies have suggested improved processes of care in GWTG-Stroke–participating hospitals, it is not known whether this improved care translates into improved clinical outcomes compared with nonparticipating hospitals.(You can't compare GWTG hospitals against each other)

Methods—From all acute care US hospitals caring for Medicare beneficiaries with acute stroke between April 2003 and December 2008, we matched hospitals that joined the GWTG-Stroke program with similar hospitals that did not. Using a difference-in-differences design, we analyzed whether hospital participation in GWTG-Stroke was associated with a greater improvement in clinical outcomes compared with the underlying secular change.

Results—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. Compared with the Pre period (18–6 months before program implementation), in the Early period (0–6 months after program implementation), GWTG-Stroke hospitals had accelerated increases in discharge to home and reduced mortality at 30 days and 1 year. In the Sustained period (6–18 months after program implementation), the accelerated reduction in mortality at 1 year was sustained, with a trend toward sustained accelerated increase in discharge home.

Conclusions—Hospital adoption of the GWTG-Stroke program was associated with improved functional outcomes at discharge and reduced postdischarge mortality.