Date of Conferral

2022

Degree

Ph.D.

School

Public Health

Advisor

Howell Sasser

Abstract

Stroke is a leading cause of mortality in the United States, particularly in a cluster of states termed the stroke belt. This study examined the efficacy of the Get With The Guidelines (GWTG)-Stroke program in stroke belt hospitals (SBHs) compared to non-stroke belt hospitals (NSBHs) regarding disparities related to mortality and acute ischemic stroke (AIS) treatment (i.e., recombinant tissue-type plasminogen activator [r-tPA] rates, Door-to-Needle [DTN], Door-to-Imaging [DTI]). Use of the GWTG-Stroke program was assessed to determine if SBHs and NSBHs were quantitatively equivalent in terms of specific core stroke measures. This quantitative employed an equivalence study design with over 2.9 million cases of secondary data from 2015 to2019 contained in the GWTG. Two one-sided-tests statistical analysis was performed on the American Heart Association’s Precision Management Platform using an R package. Inclusionary criteria were AIS diagnosis, age of 18 years or older, and treatment at a hospital using the GWTG-Stroke program. Hospital and patient-level analyses were completed for each research question and differed based on level of analysis. Patient-level analysis revealed SBHs and NSBHs using the GWTG-Stroke program were equivalent in terms of DTN time and ischemic stroke only mortality; DTI was not equivalent. Hospital-level analysis revealed that r-tPA administration was equivalent, while DTN, DTI, and mortality were not equivalent. Study results will aid in promoting awareness and expansion of the value of structured and data-driven quality-improvement interventions that the GWTG-Stroke program uses in other healthcare settings.

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