ABSTRACT
Acute stroke can result in neurological impairment or death. The Colorado Stroke Alliance and the Colorado Stroke Registry have made progress toward improving stroke care through their statewide quality improvement efforts. This report is a follow-up to a previous publication in the Journal of Neuroscience Nursing. The previous report focused on the organization and structure of the Colorado Stroke Alliance. The present report describes some of the successes and insights that have been achieved, including adherence to stroke quality indicators, gender disparities, process times for intravenous recombinant tissue plasminogen activator/alteplase, the impact of emergency medical services, and the role that nurses continue to have as agents of change in improving hospital care.
Subject(s)
Health Services Accessibility/organization & administration , Quality Improvement/organization & administration , Quality Indicators, Health Care/organization & administration , Registries , State Health Plans/organization & administration , Stroke/nursing , Colorado , Cooperative Behavior , Evidence-Based Medicine , Fibrinolytic Agents/therapeutic use , Guideline Adherence , Healthcare Disparities , Humans , Interdisciplinary Communication , Outcome Assessment, Health Care , Practice Guidelines as Topic , Stroke/mortality , Survival Analysis , Thrombolytic Therapy/nursing , Tissue Plasminogen Activator/therapeutic useABSTRACT
Acute stroke can result in neurological impairment and potentially death. The Colorado Stroke Alliance has made significant progress in improving stroke care through their statewide quality improvement efforts. The following provides an overview of how this effort has come to fruition. Included is an overview of the collaboration, an explanation of the organizational structure, the source of funding, a description of the statewide quality efforts improvement including mentoring and data reporting, and an overview of nursing involvement. This discussion highlights how a relatively small task force has transformed into a growing nonprofit organization, becoming a model for best practices.
Subject(s)
Community Networks/organization & administration , Hospitals , Interinstitutional Relations , State Health Plans/organization & administration , Stroke/therapy , Total Quality Management/organization & administration , Acute Disease , Advisory Committees/organization & administration , Benchmarking , Colorado/epidemiology , Cooperative Behavior , Cost of Illness , Health Planning Guidelines , Hospitals/standards , Hospitals/statistics & numerical data , Humans , Nurse's Role , Outcome and Process Assessment, Health Care , Practice Guidelines as Topic , Program Development , Registries , Stroke/diagnosis , Stroke/economics , Stroke/epidemiologyABSTRACT
BACKGROUND AND PURPOSE: Gender differences in stroke are matters of increasing interest. The American Stroke Association's patient management tool, Get with the Guidelines-Stroke (GGS) is widely used to increase adherence to quality indicators in stroke care, but it also provides an opportunity to analyze gender differences in the acute stroke setting. METHODS: We used a state-wide database, based on GGS, to explore gender differences in stroke in Colorado. We analyze demographics, risk factors, lifestyles, treatments, and responses to treatment. RESULTS: Of 126 data elements examined, statistically significant gender differences were noted for 47 (37%). As compared to men, women in Colorado were older and more significantly impacted by acute stroke. Risk factor profiles differed between the 2 genders, with men having a higher incidence of coronary artery disease, dyslipidemia, diabetes, carotid stenosis and tobacco smoking, while women had a higher incidence of atrial fibrillation and hypertension. Lipids were less aggressively treated and antithrombotics were less commonly used in women. Overall, acute stroke treatment of women appeared "less aggressive" than for men. CONCLUSIONS: GGS may be used not only for quality improvement initiatives in individual hospitals. It can also give an overview of clinical aspects of stroke at a state level, and may shed light on gender differences.
