December 2009: Volume 35, Number 12
Report: Stroke Care Needs Improvement
A new report on stroke registry data from four states indicates that although stroke care has improved, further advances need to be made at both the healthcare system and institution levels (MMWR 2009;58:1–23). The information comes from the Paul Coverdell National Acute Stroke Registry (PCNASR), a U.S. Centers for Disease Control and Prevention-sponsored initiative to track and improve hospital-based acute stroke care.
From 2005 to 2007, PCNASR tracked 10 care performance measures involving 195 hospitals and nearly 57,000 patients in Georgia, Illinois, Massachusetts, and North Carolina through registries maintained by state health departments. A separate prototype phase took place between 2001 and 2004, with the registries led by CDC-sponsored investigators in academic and medical institutions.
Patients included in PCNASR were at least 18 years old and had a clinical diagnosis of acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, transient ischemic attack (TIA) or an ICD-9-CM code indicative of stroke or TIA. Ischemic stroke was the most common diagnosis accounting for 53.3% of cases.
Lab testing was among the performance measures with the most improvement. During the prototype phase, only one-third of patients had lipid levels measured either after hospitalization for stroke or within 30 days before the stroke with the results available in the medical record. However, in the 2005–2007 timeframe, this indicator was recorded for nearly 70% of patients. Other measures with significant improvements included dysphagia screening, smoking cessation counseling, and antithrombotic therapy prescribed at discharge.
At the healthcare system level, the report emphasizes the need for greater public awareness about the symptoms of stroke and the importance of seeking care immediately. About half of patients with ischemic stroke lacked documented information on time of symptom onset, and an additional 25% arrived too late to receive tissue plasminogen activator therapy, a level that was unchanged between the prototype and 2005–2007 timeframes.