Closing gaps between evidence-based stroke care guidelines and practices with a collaborative quality improvement project.

BACKGROUND: Michigan's prototype of the Paul Coverdell National Acute Stroke Registry revealed improvement opportunities in acute stroke care. METHODS: A partnership among the registry investigators, American Stroke Association (ASA), Michigan Department of Community Health, and 13 Michigan hospitals was implemented in 2004. The Institute for Healthcare Improvement Breakthrough Series model and the ASA's Get With The Guidelines-Stroke program and Patient Management Tool (PMT) were used to implement tailored stroke practice guidelines at each hospital. RESULTS: Significant improvements (p < .05) were observed for 5 of the 16 measures. Smoking cessation increased by 31%, dysphagia screening increased by 19%, use of the NIH stroke scale increased by 19%, documentation of reasons for not using recombinant tissue plasminogen activator (rt-PA) increased 13%, and documentation of dyslipidemia increased by 9%. DISCUSSION: Clinically and statistically significant improvements can be made in acute stroke care using a collaborative and systematic approach to QI that employs protocol utilization and ongoing data collection and review as part of an organized PMT.