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Address correspondence and reprint requests to Dr. S. Claiborne Johnston, Department of Neurology, Box 0114, University of California, San Francisco, 505 Parnassus Ave., M-798, San Francisco, CA 94143-0114; e-mail: clay.johnston{at}ucsfmedctr.org
Background: Standardized order templates have been credited with improving care for several common medical conditions. The authors sought to determine whether use of standard orders would be associated with improvement in stroke care.
Methods: All patients with a discharge diagnosis of ischemic stroke were identified from seven hospitals in California participating in a CDC-sponsored Coverdell Acute Stroke Pilot Registry. The authors tracked six points of care: thrombolysis, receipt of antithrombotic medications within 48 hours, prophylaxis for deep venous thrombosis (DVT), smoking cessation counseling, and prescription of lipid-lowering and antithrombotic medications at discharge. Scoring was based on optimal treatment, defined as receiving or having a valid contraindication to a given intervention. Baseline scores in year 1 were compared to those in year 2, after implementation of an intervention based upon standardized stroke orders.
Results: Overall, rates of optimal treatment improved for patients treated in year 2 (n = 226) compared to year 1 (n = 187), with 63% of patients receiving a perfect score in year 2 compared to 44% in year 1 (p < 0.0001). Rates significantly improved in four of six hospitals, when the hospital was considered the unit of intervention, and for four of the six specific measures. A seventh hospital that participated in the registry but did not implement standardized orders showed no improvement in optimal treatment.
Conclusions: Implementation of standardized stroke orders and registry monitoring was associated with improvements in utilization of a number of proven interventions. Although these data are observational, they demonstrate the potential impact of simple system-wide interventions in improving care of stroke.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the August 9 issue to find the title link for this article.
See Commentary, page 341
*Members of the California Acute Stroke Pilot Registry are listed in the Appendix.
Supported by the CDC (U50 CCU920271).
Disclosure: The authors report no conflicts of interest.
Received December 23, 2004. Accepted in final form April 19, 2005.
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