After 20 years of Get With The Guidelines data, researchers find the program is ‘integral’ to nationwide stroke systems of care
New research shows the key role quality improvement programs play in ensuring hospitals can adequately fight one of the biggest public health threats facing our country: stroke.
Stroke remains the No. 5 cause of death and the leading cause of long-term disability in the United States. When a stroke happens, early detection and treatment are key to improving survival, minimizing disability and accelerating recovery times.
Yet, in the early 2000s, there was wide variability in management of stroke, and many patients did not receive recommended interventions. The American Heart Association set out to change that.
In 2003, the Association launched Get With The Guidelines - Stroke, a hospital registry program designed to ensure patient care is aligned with the latest research- and evidence-based guidelines.
Early results demonstrated that Get With The Guidelines implementation was associated with improvements in acute stroke care and secondary prevention.
Early successes continued to build
This new research, published in Stroke, builds on those findings and shows Get With The Guidelines - Stroke has become an integral part of stroke clinical practice and research in the U.S.
More than 9 million stroke cases have been entered into its registry from more than 2,800 hospitals, capturing about three-quarters of stroke hospitalizations across the country.
Analyses of data collected by GWTG-Stroke hospitals have demonstrated that participation in the program is associated with sustained improvements in the quality of care. Over the initial five years of the program, the IV tPA treatment rate among eligible patients arriving within 2 hours from the last known well increased from 42% to 73%, smoking cessation counseling increased from 74% to 88%, and DVT prophylaxis increased from 74% to 90%. In later years, treatment rates for antithrombotic and anticoagulation medications achieved nearly 100%.
The importance of the Get With The Guidelines program to the stroke community can be gauged by the program’s sustained growth and widespread dissemination of findings, which demonstrate sustained increases in both quality of care and patient outcomes over time, the authors write.
Further, the program has established a community of researchers responsible for broad dissemination of registry findings
“These findings are particularly relevant in the context of stroke care, where the goal is not only to save lives but also to restore function and maintain quality of life,” said Gregg C. Fonarow, M.D., FAHA, an author of the study and director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of the Preventative Cardiology Program, and the Eliot Corday Chair in Cardiovascular Medicine and Science at the University of California, Los Angeles.
Forces driving the program’s success
Researchers found a key driver of the sustained growth in Get With The Guidelines – Stroke was creation of a hospital stroke certification by The Joint Commission, other hospital certifying organizations and state-level programs. These certifications made collection and submission of performance data and ongoing quality improvement an essential part of their work.
Get With The Guidelines recognition from the American Heart Association also helped to formally acknowledge hospitals’ work, motivating team efforts and raising visibility in participants’ communities.
Finally, an open process to submit ideas for specific hypothesis-driven analyses and access to de-identified Get With The Guidelines – Stroke data through the Association’s Precision Medicine Platform have increased the reach of these data to interested researchers across the globe.
“Quality health care is built on providing the right care, at the right time, in the right manner ... with the aim of achieving the best possible outcomes — this study shows that science-backed guidelines and the Get With The Guidelines – Stroke system of care helps us do that,” Fonarow said. “Stroke is an exquisitely time-sensitive disease and Get With The Guidelines promotes delivery of evidence-based acute stroke care in a timely fashion, which in turn improves patient-centered clinical outcomes.”
Get With The Guidelines – Stroke as a model
While the program represents a “major success story,” the authors note that technological and regulatory environments affecting health care data in the United Sates are ever-changing. Therefore, the registry needs to remain vigilant as it looks to the future.
But these challenges haven’t stopped growth. Since the launch of the stroke program, Get With The Guidelines quality improvement modules have been added to cover atrial fibrillation, coronary artery disease, heart failure and resuscitation. Each program promotes consistent adherence to the latest research-driven guidelines and measurement, while providing data and information to professionals for continual improvement in patient care. All Get With The Guidelines modules are associated with significant improvements in multiple processes of care strongly linked to improved outcomes.