Defect-free care trends in the Paul Coverdell National Acute Stroke Program, 2008-2018

• Published in: The American heart journal 2021-02, Vol.232, p.177-184
• Main Authors: Overwyk, Katherine J, Yin, Xiaoping, Tong, Xin, King, Sallyann M Coleman, Wiltz, Jennifer L
• Format: Article
• Language: English
• Subjects: Adult; African Americans - statistics & numerical data; Age Factors; Aged; Atrial Fibrillation; Dysphagia; Education; Female; Fibrillation; Government programs; Guideline Adherence - trends; Healthcare Disparities - ethnology; Healthcare Disparities - statistics & numerical data; Hemorrhage; Hemorrhagic Stroke - therapy; Hispanic or Latino - statistics & numerical data; Hispanic people; Humans; Hypertension; Ischemia; Ischemic Attack, Transient - therapy; Ischemic Stroke - therapy; Male; Medicaid; Medicaid - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Middle Aged; Patients; Practice Guidelines as Topic; Quality control; Quality Indicators, Health Care; Quality of Health Care - trends; Sex Factors; Stroke; Subgroups; Teaching hospitals; Transient ischemic attack; Trends; United States; Whites - statistics & numerical data; Young Adult
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2020.11.010

In an effort to improve stroke quality of care and patient outcomes, quality of care metrics are monitored to assess utilization of evidence-based stroke care processes as part of the Paul Coverdell National Acute Stroke Program (PCNASP). We aimed to assess temporal trends in defect-free care (DFC) received by stroke patients in the PCNASP between 2008 and 2018. Quality of care data for 10 performance measures were available for 849,793 patients aged ≥18 years who were admitted to a participating hospital with a clinical diagnosis of stroke between 2008 and 2018. A patient who receives care according to all performance measures for which they are eligible, receives "defect-free care" (DFC) (eg, appropriate medications, assessments, and education). Generalized estimating equations were used to examine the factors associated with receipt of DFC. DFC among ischemic stroke patients increased from 38.0% in 2008 to 80.8% in 2018 (P < .0001), with the largest improvement seen in receipt of stroke education (relative percent change, RPC = 64%). Similarly, DFC for hemorrhagic stroke and transient ischemic attack patients increased from 46.7% to 82.6% (RPC = 76.9%) and 39.9% to 85.0% (RPC = 113.0%) (P < .001), respectively. Among ischemic stroke patients, the adjusted odds for receiving DFC were lower for women, patients aged 18 to 54 years, Medicaid or Medicare participants, and patients with atrial fibrillation (P < .05). From 2008 to 2018, receipt of DFC by ischemic stroke patients significantly increased in the PCNASP; however certain subgroups were less likely to receive this level of care. Targeted quality improvement initiatives could result in even further improvements among all stroke patients and help reduce disparities in care.