Improving Stroke Outcomes for African Americans

中风是美国第三大死亡原因，也是导致成人长期残疾的主要原因之一，对非裔美国人的影响很大。由于90%的中风幸存者功能受损，改善中风预后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(QI)在内的绩效计划，理想情况下，QI是根据对中风相关结果的影响来选择的，但目前此类证据很少。医学研究所表示：“关于医疗保健工作的公正、可靠的信息对于减少 卫生保健服务使用的地域差异，并提高质量。 与急性缺血性中风(AIS)护理相关的QLS研究及其与预后的关系 心血管疾病[心血管疾病]死亡率、心血管事件和功能独立性。总体目标是 制定一套最优的AIS护理QL，使患者的长期结果最大化 并针对特定的患者群体，如非裔美国人和患有慢性肾脏病的AIS患者 疾病(CKD)或糖尿病，两者在非裔美国人中更常见。我们的目标是1)检查 AIS管理的指南一致性过程中的变化，假设指南一致性护理 会因患者、医院和地区因素而异，遵守CMS QLS，但不遵守其他潜在的QLS 将在2003-2012年期间有所改善；2)审查AIS管理过程与成果之间的联系； 包括CMS数据的增量和相对有效性以及70%的成本效益。 假设指南一致的护理与较低的住院并发症和死亡率相关， 一年后，首次AIS住院期间符合指南的住院治疗与 再发卒中、心肌梗死(Ml)、心血管病死率低、功能独立性高； 研究AIS治疗过程与CKD或AIS患者预后之间的关系 糖尿病，假设CKD或糖尿病患者接受的与指南一致的治疗比 其他人，慢性肾脏病和糖尿病患者接受符合指南的护理将有更好的结果 但CKD和糖尿病患者优化生活质量的QLS集将有所不同 与为AIS患者提供的整体服务相同。这项研究将包括AIS护理流程的正式图表摘要 在1200个主题中，将使用关于医院特征的公开可用数据，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.