Abstract 8: Association Between Hospital "Get With The Guidelines-Stroke" Performance Measures And Outcomes Among Patients With Acute Ischemic Stroke In China
Authors: Li Zixiao , Wang Yongjun , Wang Yilong , Zhao Xingquan , Wang Chunxue , Liu Liping , Wang Chunjuan , Zhang Changqing , Pan Yuesong , Yang Xiaomeng 
Published: July 2021

Background:
To assess contemporary care practices consistent with the evidence-based performance measures adopted by GWTG-Stroke and whether the composite measure rate was associated with in-hospital outcomes, the Second China National Stroke Registry (CNSRII), a national hospital-based, prospective registry, was initiated by the Ministry of Health of China.

Methods:
Between January 2012 and February 2013, CNSRII recruited 31,048 patients with stroke or transient ischemic attack from 221 hospitals throughout China. Among 24,597 patients with acute ischemic stroke, adherence to seven GWTG-Stroke performance measures (Intravenous tissue plasminogen activator within 3 hours of symptom onset, Deep Venous Thrombosis prophylaxis, Early and Discharge antithrombotics, Anticoagulation for atrial fibrillation, Lipid-lowering for LDL ≥100 mg/dl, and Smoking cessation), all-or-none measure and composite measure (defined as the total number of performance measure interventions performed among eligible patients divided by the total number of possible performance measure interventions among eligible patients) were assessed. The association between the composite measure adherence quartile and unadjusted in-hospital outcome (death, pneumonia and venous thromboembolism) was evaluated using the Pearson correlation coefficients. The multivariate logistic regression was employed to examine the association between composite measure with in-hospital outcomes and adjusted by age, gender, admission NIHSS, health insurance, history of prior stroke/TIA, diabetes, hypertension, atrial fibrillation or flutter, coronary artery diseases/MI, peripheral vascular disease, dyslipidemia, carotid stenosis, and smoker.

Results:
Among 24,597 patients with acute ischemic stroke, conformity with 7 performance measures ranged from 13.7% (259 of 1,897) for tPA use to 96.5% (23,247 of 24,079) for early antithrombotics. The all-or-none measure and composite measure were 55.5% and 82.1% separately. The composite measure rate was significantly associated with in-hospital death and pneumonia, with observed mortality rates decreasing from 4.8% (32 of 667) for the lowest adherence quartile to 0.4% (56 of 14212) for the highest adherence quartile (P<.001), and observed pneumonia rates decreasing from 20.3% (133 of 667) for the lowest adherence quartile to 4.8% (670 of 14212) for the highest adherence quartile (P<.001). After risks adjustment, multivariate models showed that composite measure adherence was associated with in-hospital outcomes of death (adjusted OR: 0.075 with 95% CI: 0.048-0.118, P<.001) and pneumonia (adjusted OR: 0.256 with 95% CI: 0.212-0.310, P<.001).

Conclusions:
A significant association between hospital care process and outcomes was found, supporting the use of GWTG-Stroke performance metrics as a means of assessing and helping improve stroke care quality in China.