Table 5.
Additional Stroke Measure Conformity by Hospital PAA Recognition and PSC Certification Status: Unadjusted and Adjusted ORs
| Stroke Measures | Hospital Status (Reference PAA−/PSC−) | Unadjusted | Adjusted for Patient Factors* | Adjusted for Patient and Hospital Factors* | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| OR | Lower 95% CI | Upper 95% CI | OR | Lower 95% CI | Upper 95% CI | OR | Lower 95% CI | Upper 95% CI | ||
| IV TPA arrived by 3.5 hours and used to treat by 4.5 hours | PAA+/PSC+ | 4.59 | 3.93 | 5.36 | 4.56 | 3.90 | 5.33 | 2.83 | 2.43 | 3.31 |
| PAA+/PSC− | 3.45 | 2.95 | 4.03 | 3.41 | 2.91 | 3.99 | 2.73 | 2.34 | 3.19 | |
| PAA−/PSC+ | 2.12 | 1.67 | 2.70 | 2.08 | 1.64 | 2.63 | 1.56 | 1.24 | 1.97 | |
| Door‐to‐brain imaging within 25 minutes | PAA+/PSC+ | 1.35 | 1.20 | 1.51 | 1.34 | 1.19 | 1.51 | 1.23 | 1.09 | 1.40 |
| PAA+/PSC− | 1.34 | 1.19 | 1.50 | 1.34 | 1.19 | 1.50 | 1.29 | 1.14 | 1.45 | |
| PAA−/PSC+ | 1.26 | 1.04 | 1.52 | 1.26 | 1.05 | 1.52 | 1.19 | 0.99 | 1.44 | |
| Door‐to‐needle time within 60 minutes | PAA+/PSC+ | 1.45 | 1.25 | 1.68 | 1.47 | 1.27 | 1.71 | 1.08 | 0.93 | 1.26 |
| PAA+/PSC− | 1.38 | 1.19 | 1.59 | 1.39 | 1.20 | 1.62 | 1.18 | 1.02 | 1.37 | |
| PAA−/PSC+ | 0.79 | 0.60 | 1.03 | 0.78 | 0.59 | 1.03 | 0.68 | 0.53 | 0.87 | |
| Dysphagia screening | PAA+/PSC+ | 4.06 | 3.56 | 4.62 | 4.00 | 3.51 | 4.57 | 3.49 | 3.01 | 4.05 |
| PAA+/PSC− | 3.27 | 2.83 | 3.78 | 3.29 | 2.84 | 3.80 | 3.00 | 2.57 | 3.50 | |
| PAA−/PSC+ | 2.92 | 2.36 | 3.62 | 2.91 | 2.34 | 3.62 | 2.62 | 2.10 | 3.27 | |
| LDL documented | PAA+/PSC+ | 3.10 | 2.78 | 3.45 | 3.20 | 2.85 | 3.59 | 2.61 | 2.30 | 2.95 |
| PAA+/PSC− | 2.40 | 2.12 | 2.71 | 2.47 | 2.17 | 2.81 | 2.21 | 1.95 | 2.51 | |
| PAA−/PSC+ | 1.81 | 1.50 | 2.19 | 1.89 | 1.53 | 2.35 | 1.63 | 1.31 | 2.02 | |
| Intensive statin therapy | PAA+/PSC+ | 1.54 | 1.31 | 1.80 | 1.70 | 1.47 | 1.97 | 1.50 | 1.27 | 1.76 |
| PAA+/PSC− | 1.72 | 1.46 | 2.03 | 1.66 | 1.43 | 1.94 | 1.51 | 1.29 | 1.77 | |
| PAA−/PSC+ | 1.30 | 0.99 | 1.69 | 1.37 | 1.06 | 1.77 | 1.36 | 1.04 | 1.77 | |
| Weight loss counseling for BMI ≥25 kg/m2 | PAA+/PSC+ | 2.25 | 1.83 | 2.77 | 2.27 | 1.84 | 2.80 | 2.13 | 1.68 | 2.70 |
| PAA+/PSC− | 2.08 | 1.69 | 2.56 | 2.05 | 1.67 | 2.52 | 1.94 | 1.56 | 2.41 | |
| PAA−/PSC+ | 1.58 | 1.14 | 2.18 | 1.52 | 1.10 | 2.11 | 1.55 | 1.11 | 2.16 | |
| Stroke education | PAA+/PSC+ | 6.16 | 5.26 | 7.22 | 5.95 | 5.09 | 6.96 | 4.81 | 4.06 | 5.71 |
| PAA+/PSC− | 3.70 | 3.09 | 4.42 | 3.65 | 3.05 | 4.36 | 3.18 | 2.63 | 3.84 | |
| PAA−/PSC+ | 3.15 | 2.47 | 4.01 | 2.82 | 2.16 | 3.67 | 2.47 | 1.89 | 3.22 | |
| Stroke rehabilitation | PAA+/PSC+ | 4.63 | 3.97 | 5.39 | 4.69 | 3.97 | 5.53 | 3.73 | 3.12 | 4.46 |
| PAA+/PSC− | 3.11 | 2.69 | 3.59 | 3.08 | 2.64 | 3.60 | 2.79 | 2.38 | 3.26 | |
| PAA−/PSC+ | 2.25 | 1.73 | 2.92 | 2.13 | 1.54 | 2.96 | 1.83 | 1.33 | 2.52 | |
BMI indicates body mass index; CAD, coronary heart disease; IV, intravenous; MI, myocardial infarction; OR, odds ratio; PAA, Performance Achievement Award; PSC, Primary Stroke Center; PVD, peripheral vascular disease; TIA, transient ischemic attack; TPA, tissue‐type plasminogen activator.
Adjusted for age, sex, race, medical history of atrial fibrillation/flutter, prosthetic heart valve, previous stroke/TIA, CAD/prior MI, carotid stenosis, diabetes, PVD, hypertension, smoking, dyslipidemia, and heart failure, arrived at off‐hours (holiday or before 7 am/after 6 pm on Monday to Friday).
Adjusted for patient characteristics and hospital characteristics of region, number of beds, teaching status, annual ischemic stroke volume, and annual IV TPA treatment volume.