Abstract Body: Background: Reducing the time between ischemic stroke onset and intravenous thrombolysis (IVT) is crucial for treatment effectiveness. Through a grassroots effort, the Florida Stroke Registry (FSR) developed regional dashboards (RDs) displaying reperfusion treatment metrics from hospitals participating voluntarily in local Stroke Coalitions with the goal of improving quality of acute stroke care. We sought to evaluate whether RD utilization is associated with faster IVT treatment times, as well as with improved hospitalization outcomes.
Methods: We conducted a cross-sectional analysis across the FSR, a statewide registry across Get With the Guidelines-Stroke participating hospitals. We included ischemic stroke cases receiving IVT from January 2016 to December 2023. Cases were categorized by whether they received IVT at hospitals actively participating in the RD initiative or not at their time of treatment. Primary study endpoints were door-to-treatment (DTT) time <20 minutes and onset-to-treatment (OTT) time <60 minutes, while secondary endpoints comprised hospitalization outcomes. Logistic regression models, adjusted for calendar year, patient characteristics, and hospital factors, were used to examine the association between RD utilization and study endpoints.
Results: Ninety-two out of 172 FSR hospitals participated in Stroke Coalitions and RD by the end of the study period. The analysis included 32,320 IVT-treated cases (mean age 69 ±15 years, 48.4% female). Of these, 10,666 (33%) were treated at hospitals participating in the RD initiative. Regional Dashboards utilization was independently associated with DTT <20 minutes (12.7% vs. 7.3%; aOR=1.48, 95%CI 1.35-1.63) and OTT <60 minutes (13.9% vs. 9.0%; aOR=1.63, 95%CI 1.49-1.80), as well as increased likelihood of being discharged directly to home (aOR=1.15; 95%CI 1.07-1.23) and functional independence at discharge (aOR=1.49; 95%CI 1.39-1.59). Hospitals using RD had better thrombolysis times than non-participating hospitals from their first year in Stroke Coalitions, with further improvements after 3 to 4 years of participation (Figure).
Conclusion: The FSR RD initiative applied within Stroke Coalitions was associated with faster IVT treatment times and improved hospitalization outcomes. This quality improvement initiative, adaptable to local needs, could emerge as a valuable tool for enhancing stroke systems of care.