At the Cedars-Sinai Stroke Program, the care given to persons who have had a stroke is measured against the standards created in the Get With the Guidelines program sponsored by the American Heart Association and the American Stroke Association.
The Get With the Guidelines - Stroke program is an in-hospital program designed to improve the treatment given to people who have had an acute stroke. The guidelines are based on the latest scientific research in the treatment of stroke. They focus on quick diagnosis and treatment after a stroke and actions to prevent future strokes. These measures include:
- Types of Strokes Treated at Cedars-Sinai Medical Center
- Timely Administration of the Drug tPA
- Stroke Patient Education
- Rehabilitation Plans Following a Stroke
- Mortality Rate Following a Stroke
- Discharge After Treatment for a Stroke
- Functional Independence Improvements Following Treatment for a Stroke During Inpatient Rehabilitation
The Get With the Guidelines (GWTG) Aggregate Data report was generated using the OutcomeTM PMT system. Copy or distribution of the GWTG Aggregate Data is prohibited without the prior written consent of the American Heart Association and Outcome Services, Inc. (Outcome) The data reported here is from the report run in April 2013 reflecting 2012 data.
Currently, 2243 hospitals are participating in the Get With the Guidelines program. They have contributed information on 2,470,336 patients in 2012.
Cedars-Sinai Earns Comprehensive Stroke Center Certification
The Joint Commission and the American Heart Association / American Stroke Association established Stroke Center Certification in 2003 to promote excellent stroke care in hospitals across the United States. Currently more than 900 Joint Commission certified Primary Stroke Centers have established a formal program to treat stroke patients effectively and consistently with the goal of improving care and outcomes.
In September 2012, The Joint Commission, in collaboration with the American Heart Association/American Stroke Association’s Brain Attack Coalition, began certifying two levels of stroke care, "primary" and "comprehensive." Comprehensive Stroke Centers offer the highest level of care, including neuro-intensive care units, complex neurosurgical interventions, and advanced brain and blood-vessel imaging.
This Advanced Certification for Comprehensive Stroke Centers (CSC) recognizes the significant resources in staff and training that comprehensive stroke centers must have to treat complex stroke cases.
Cedars-Sinai was proud to be among the first 5 in the nation to receive this prestigious and rigorous designation and the first Comprehensive Stroke Center in Southern California.
Cedars-Sinai Medical Center Recognized with "Get With the Guidelines" Gold Plus Award
The American Heart Association and the American Stroke Association have recognized Cedars-Sinai Medical Center with a Gold Plus Performance Achievement Award in 2008.
This award recognizes Cedars-Sinai's performance over 24 consecutive months. This prestigious award demonstrates 85% compliance with all 10 "Get With The Guidelines" measures. The Plus awards represent a current gold or silver award and additional 75% compliance with module-specific quality measures for at least 12 consecutive months.
The data below on stroke patients treated at Cedars-Sinai reflects treatment given to 913 stroke patients discharged during 2012.
Profile of Patients Receiving Stroke Treatment at Cedars-Sinai
The chart below compares the type of patients treated at Cedars-Sinai Medical Center with all patients reported by hospitals nationally participating in the Get With the Guidelines program. The average age of patients treated at Cedars-Sinai is 73, which is 2 years older than the national average of 71.
Patients treated at Cedars-Sinai Medical Center had one of the following types of strokes:
- Hemorrhagic, where blood leaks from a blood vessel into brain tissue. This type of stroke can take two forms. A Subarachnoid hemorrhage where a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) quickly fills with blood. The second type is an intracerebral hemorrhage, in which there is bleeding inside the brain that causes a build up of pressure and damage to brain cells.
- Ischemic, where a blood clot shuts off the flow of blood to parts of the brain
- Transient ischemic attacks (TIA)
The chart below compares the percentage of people treated for each type of stroke at Cedars-Sinai and nationally.
Tissue plasminogen activator (tPA) is a powerful drug used to break up blood clots that cause ischemic strokes. The drug is usually given through a vein in the arm. To be effective, the drug must be given within four-and-a-half hours after a stroke occurs. Not all people having ischemic strokes benefit from tPA. The drug has certain side effects that a doctor must consider before deciding whether tPA is the best treatment for a stroke patient.
Patient education following a stroke can help prevent future strokes. The chart below compares how many Cedars-Sinai patients received education following a stroke compared to hospitals nationally.
A stroke can cause damage to the brain that makes it difficult for a person to return to his or her normal daily activities. Rehabilitation after a stroke can help a person live with any remaining effects of a stroke. It can also help the brain recover more fully. The chart below shows the percentage of stroke patients treated at Cedars-Sinai for whom a rehabilitation plan was considered. These data are compared to hospitals nationally.
Of the patients admitted to Cedars-Sinai Medical Center following a stroke, 8.3% died while in the hospital. This compares to an average of 6.2% for other hospitals nationally participating in the Get With the Guidelines program.
It should be noted that a higher percentage of patients treated at Cedars-Sinai Medical Center had hemorrhagic strokes compared to patients at other "Get With The Guidelines" hospitals. A total of 19.8% of the patients treated at Cedars-Sinai had that type of stroke. At other "Get With the Guidelines" hospitals, only 14.0% of the patients treated had hemorrhagic strokes.
The following chart shows the percentage of patients who were discharged to their own homes (with and without home health care), inpatient rehabilitation, skilled nursing facilities or other places.
Functional Independence Improvements Following Treatment for a Stroke During Inpatient Rehabilitation
A patient's ability to do activities of daily living without help is measured by a tool called the Functional Improvement Measure (FIM) ™. Using this tool, rehabilitation specialists working with patients can measure their progress from admission through discharge.
The Uniform Data System for Medical Rehabilitation is the national benchmark providing a way to document functional severity and the results of medical rehabilitation. Through the use of the Functional Independence Measure ™ (FIM), clinicians follow changes in functional status from admission to discharge. The FIM contains 18 items that assess severity of disability and level of functional independence on a 7 point scale.
Ratings are performed in the areas of self-care, sphincter control, mobility, communication, and social cognition. Ratings are established by the interdisciplinary team at admission to inpatient rehabilitation and at discharge from inpatient rehabilitation. Outcomes are measured by taking the numeric difference between the admission FIM and the discharge (FIM). FIM scores range from 18 (dependent) to 126 (independent).
The chart below shows the average functional independence score of patients admitted to Cedars-Sinai following a stroke, the improvement in FIM score during treatment and their FIM score at discharge.