Predictors of increased intravenous tissue plasminogen activator use among hospitals participating in the Massachusetts Primary Stroke Service Program.
Predictors of increased intravenous tissue plasminogen activator use among hospitals participating in the Massachusetts Primary Stroke Service Program.
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DOI：
10.1161/circoutcomes.111.962829
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发表时间：
2012-05
期刊：
影响因子：
--
通讯作者：
Schwamm LH
中科院分区：
文献类型：
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作者：
Rost NS;Smith EE;Pervez MA;Mello P;Dreyer P;Schwamm LH
我们试图确定IV tPA治疗急性缺血性卒中（AIS）的使用是否在马萨诸塞州与初级卒中服务（PSS）计划（一项全州卒中中心指定和质量改进（QI）计划）相关。我们分析了2004年10月至2008年6月期间从马萨诸塞州公共卫生部（DPH）获得的前瞻性数据，包括69家参与的马萨诸塞州PSS医院中风发作后≤3小时的10045例连续ED-based AIS遭遇。在症状出现≤2小时的患者中，静脉注射tPA的总使用率为854/3866（22.1%）。IV tPA的使用从2005年（该计划的第一个完整年度）到2008年稳步增长（18.4%,21.9%,22.6%,25.5%,p=0.001）。静脉tPA治疗的患者更年轻（72.3±14.1比74.7±14.0,p<0.005），并且在2005年7月EMS改道后就诊（96%比94%，p=0.009）。获得“遵循指南-卒中”项目绩效成就奖的患者在获得奖励后接受静脉注射tPA的可能性比在获得奖励前更高（28.1%比22.3%,p<0.001）。在这个几乎完整的全州数据捕获中，与州PSS指定计划相关的IV tPA率在2005年至2008年期间在马萨诸塞州显著提高。需要进一步的研究来证实老年AIS患者存在治疗差异，并且溶栓率的增加超出了长期趋势。
We sought to determine if IV tPA use for acute ischemic stroke (AIS) increased in Massachusetts in association with the Primary Stroke Service (PSS) program, a statewide stroke center designation and quality improvement (QI) initiative. We analyzed prospectively acquired data from the Massachusetts Department of Public Health (DPH) between October 2004 and June 2008 including 10,045 consecutive ED-based AIS encounters arriving ≤3 hrs after stroke onset at 69 participating Massachusetts PSS hospitals. The overall rate of IV tPA use was 854/3866 (22.1%) of patients arriving ≤2 hours of symptom onset. IV tPA use increased steadily from 2005 (the first full year of the program) to 2008 (18.4%, 21.9%, 22.6%, 25.5%, p=0.001). Patients treated with IV tPA were more likely to be younger (72.3±14.1 vs. 74.7±14.0, p<0.005) and to have presented after EMS re-routing in July 2005 (96% vs. 94%, p=0.009). Patients who arrived at hospitals with a performance achievement award from the Get With The Guidelines-Stroke program were more likely to receive IV tPA after vs. before award recognition (28.1% vs. 22.3%, p<0.001). In this nearly complete capture of statewide data, rates of IV tPA improved significantly in Massachusetts from 2005 to 2008 in association with a state PSS designation program. Further studies are needed to confirm that treatment disparities exist for older AIS patients, and that the rates of thrombolysis have increased above and beyond secular trends.