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Quality of Care and Its Impact on One-Year Mortality: The Georgia Coverdell Acute Stroke Registry.
American Journal of Medical Quality : the Official Journal of the American College of Medical Quality 2018 January
Although performance measures help monitor the process change in quality improvement, their utility in measuring long-term outcomes is uncertain. This study assessed the 1-year mortality of acute ischemic stroke patients treated by hospitals participating in the Georgia Coverdell Acute Stroke Registry. Using 10 nationally approved performance measures, quality of care was defined both as an all-or-none measure (defect-free care) and as a composite index. A generalized estimating equation was applied to assess the effect of quality of care on 1-year mortality. Defect-free care did not serve the purpose; however, the composite measure showed that patients who received the lowest and intermediate quality care, respectively, had a 3.94 (95% confidence interval: 3.27, 4.75; P < .0001) and a 1.38 (95% confidence interval: 1.12, 1.62; P = .002) times higher odds of dying in 1 year compared to those who got the best-quality stroke care. Therefore, hospitals should be encouraged to implement quality improvement activities for better long-term patient outcome.
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