Improving Stroke Outcomes for African Americans

中风是第三大死亡原因，也是美国成年人长期残疾的主要原因之一，对非洲裔美国人影响很大。由于90%的中风幸存者功能受损，改善中风结局是一个主要的公共卫生问题。CMS和联合委员会等机构已经实施了包括质量指标（QIs）在内的绩效计划，理想情况下，这些指标将根据对卒中相关结局的影响进行选择，但目前此类证据很少。医学研究所指出：“关于医疗保健工作的公正，可靠的信息对于减少 保健服务使用的地理差异，以及提高质量。“我们建议系统地 与急性缺血性卒中（AIS）护理相关的研究Ql及其与 心血管疾病[CVD]死亡率、CVD事件和功能独立性。总体目标是 制定一套“最佳”AIS护理Ql，最大限度地提高患者的长期结局， 对于特定的患者群体，如非裔美国人和患有慢性肾脏病的AIS患者， 慢性肾脏病（CKD）或糖尿病，两者在非裔美国人中更为常见。我们的目标是1）检查 AIS管理的指南一致性过程的变化，假设指南一致性护理 将因患者、医院和地区因素而异，并且对CMS QLS的依从性而不是其他潜在的QLS 将在2003-12年期间得到改善; 2）检查AIS管理过程与结果之间的关联， 包括增量和相对有效性和成本效益>70%与CMS数据。 假设指南一致性护理与较低的住院并发症和死亡率相关， 一年后，在最初的AIS住院期间，指南一致的住院治疗与 具有较低的复发性卒中、心肌梗死（MI）、CVD死亡率和较高的功能独立性; 3） 检查AIS管理过程与伴有CKD的AIS患者结局之间的相关性，或 糖尿病，假设CKD或糖尿病患者接受的指南一致性治疗少于 其他，CKD和糖尿病患者接受指南一致的护理将有更好的结果 但是，优化CKD和糖尿病患者生活质量的Ql集与其他患者相比将有所不同。 与AIS患者的总体情况一致。该研究将包括AIS护理过程的正式图表抽象 在1200名REGARDS受试者中，将使用有关医院特征的临床可用数据，以及 CMS数据。

Stroke is the 3rd leading cause of death and one of the leading causes of adult long-term disability in the US, with high impact for African Americans. Since 90% of stroke survivors are functionally impaired, improving stroke outcomes is a major public health issue. Agencies such as CMS and the Joint Commission have implemented performance programs including quality indicators (QIs) which would ideally be selected based on impact on stroke-related outcomes, but such evidence is currently scant. The Institute of Medicine has stated "that unbiased, reliable information about what works in health care is essential to reducing geographic variation in the use of health care services, and improving quality." We propose to systematically study Qls related to acute ischemic stroke (AIS) care and their associations with the outcomes of cardiovascular disease [CVD] mortality, CVD events, and functional independence. The overall goal is to develop a set of "optimal" AIS care Qls that maximizes long term outcomes both for patients overall and for specific groups of patients, such as African Americans, and AIS patients with chronic kidney disease (CKD) or diabetes, both more common among African Americans. We aim to 1) examine variations in guideline-concordant process of AIS management, hypothesizing that guideline concordant care will vary by patient, hospital and regional factors, and that adherence to CMS Qls but not other potential Qls will improve over 2003-12; 2) examine associations between processes of AIS management and outcomes, including incremental and relative effectiveness and cost-effectiveness in the >70% with CMS data. hypothesizing that guideline concordant care is associated with lower in-hospital complications and mortality, and that one year later, guideline-concordant inpatient care during the initial AIS hospitalization is associated with lower recurrent stroke, myocardial infarction (Ml), CVD mortality and higher functional independence; 3) examine the association between processes of AIS management and outcomes in AIS patients with CKD or diabetes, hypothesizing that patients with CKD or diabetes will receive less guideline-concordant care than others, and that CKD and diabetes patients receiving guideline-concordant care will have better outcomes than others, but the set of Qls that optimizes quality of life for CKD and diabetes patients will differ compared with those for AIS patients overall. The study will consist of formal chart abstraction of processes of AIS care among 1200 REGARDS subjects, and will use publically available data on hospital characteristics, as well as CMS data.