Fonarow Gregg C, Reeves Mathew J, Smith Eric E, Saver Jeffrey L, Zhao Xin, Olson Dai Wai, Hernandez Adrian F, Peterson Eric D, Schwamm Lee H
University of California, Los Angeles, USA.
Circ Cardiovasc Qual Outcomes. 2010 May;3(3):291-302. doi: 10.1161/CIRCOUTCOMES.109.921858. Epub 2010 Feb 22.
Stroke results in substantial death and disability. To address this burden, Get With The Guideline (GWTG)-Stroke was developed to facilitate the measurement, tracking, and improvement in quality of care and outcomes for acute stroke and transient ischemic attack (TIA) patients in the United States.
We analyzed the characteristics, performance measures, and in-hospital outcomes in the first 1 000 000 acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and TIA admissions from 1392 hospitals that participated in the GWTG-Stroke Program 2003 to 2009. Patients were 53.5% women, 73.3% white, and with mean age of 70.1+/-14.9 years. There were 601 599 (60.2%) ischemic strokes, 108 671 (10.9%) intracerebral hemorrhages, 34 945 (3.5%) subarachnoid hemorrhages, 26 977 (2.7%) strokes not classified, and 227 788 (22.8%) TIAs. Performance measures showed small to moderate differences by cerebrovascular event type. In-hospital mortality rate was highest among intracerebral hemorrhage (25.0%) and subarachnoid hemorrhage (20.4%), and intermediate in ischemic stroke (5.5%) patients and lowest among TIA patients (0.3%). Significant improvements over time from 2003 to 2009 in quality of care were observed: all-or-none measure, 44.0% versus 84.3% (+40.3%, P<0.0001). After adjustment for patient and hospital variables, the cumulative adjusted odds ratio for the all-or-none measure over the 6 years was 9.4 (95% confidence interval, 8.3 to 10.6, P<0.0001). Temporal improvements in length of stay and risk-adjusted in-hospital mortality rate (for ischemic stroke and TIA) were also observed.
With more than 1 million patients enrolled, GWTG-Stroke represents an integrated stroke and TIA registry that supports national surveillance, innovative research, and sustained quality improvement efforts facilitating evidence-based stroke/TIA care.
中风导致大量死亡和残疾。为应对这一负担，美国制定了“遵循指南-中风”（GWTG-中风）计划，以促进对急性中风和短暂性脑缺血发作（TIA）患者护理质量和治疗结果的衡量、跟踪及改善。
我们分析了2003年至2009年参与GWTG-中风计划的1392家医院收治的前100万例急性缺血性中风、脑出血、蛛网膜下腔出血和TIA患者的特征、性能指标及住院治疗结果。患者中女性占53.5%，白人占73.3%，平均年龄为70.1±14.9岁。其中缺血性中风601599例（60.2%），脑出血108671例（10.9%），蛛网膜下腔出血34945例（3.5%），未分类中风26977例（2.7%），TIA 227788例（22.8%）。性能指标显示，不同脑血管事件类型存在小到中度差异。脑出血患者的住院死亡率最高（25.0%），蛛网膜下腔出血患者次之（20.4%），缺血性中风患者居中（5.5%），TIA患者最低（0.3%）。2003年至2009年期间，护理质量有显著改善：全或无指标，从44.0%提高到84.3%（提高40.3%，P<0.0001）。在对患者和医院变量进行调整后，6年间全或无指标的累积调整优势比为9.4（95%置信区间为8.3至10.6，P<0.0001）。住院时间和风险调整后的住院死亡率（针对缺血性中风和TIA）也有随时间的改善。
GWTG-中风计划纳入了超过100万患者，是一个综合性的中风和TIA登记系统，支持国家监测、创新性研究以及持续的质量改进工作，有助于开展基于证据的中风/TIA护理。
