Does Hospitalist Directed Care for Acute Ischemic Stroke Patients Improve Adherence to "Get with the Guidelines"?

BACKGROUND AND PURPOSE: Hospitalist directed care is associated with improved outcomes in several medical conditions. The hospitalist effect has not been studied in acute ischemic stroke (AIS) patients. We compare length of stay (LOS), outcome, and adherence to "Get with the Guidelines" (GWTG) stroke quality measures among AIS patients admitted under a hospitalist with three other specialties (internist, family practice, or specialist).

METHODS: We collected demographics, risk factors and discharge outcomes (modified Rankin Scale (mRS)) for consecutive AIS patients over 4-year period (2010-2014). We categorized all stroke admissions according to admitting physicians. We compared rates of adherence with all of the GWTG Stroke inpatient quality measures between the four groups.

RESULTS: A total of 1584 patients [mean age ( ± SD) 68.6 ± 13.7 years; 55.6% men] were admitted with AIS. There was no statistically significant difference in LOS between the four groups (p=0.4). There was significant difference in the GWTG inpatient quality measures with the hospitalist group having lowest rates of any nonadherence observed in 5% of admissions (p=0.03), and the internists had the highest rate of nonadherence observed in 16% of admissions (p=0.01). The most common deficiency was not prescribing statin at discharge (56% of total fallouts). There was no difference in rates of poor outcomes on discharge (mRS 3-6) (p=0.2).

CONCLUSIONS: There was a significantly higher rate of adherence to GWTG inpatient stroke measures when AIS patients were admitted under the care of a hospitalist. Prospective studies are required to evaluate if higher rates of adherence lead to better long term outcomes.