Door-to-Needle Time and Long-term Outcomes in Patients With Stroke —Reply

In Reply Although factors other than faster door-to-needle times may have contributed to the associations between door-to-needle times and 1-year mortality and readmission in our study, there are multiple lines of evidence to suggest that door-to-needle times contributed to improved clinical outcomes and were not just an index for generic stroke care quality. The hospitals providing data for our study were participating in Get With The Guidelines (GWTG) –Stroke, a national quality improvement initiative. Prior studies have analyzed conformity of GWTG-Stroke hospitals with standard stroke care measures, including 7 performance measures, 8 quality measures, and a defect-free care measure to summarize the overall conformity with the 7 performance me asures for each hospital. The data showed that hospitals participating in GWTG-Stroke had overall high conformity to these measures, with exceptions in door-to-needle times. Furthermore, in the present study, although there was some imbalance in hospital characteristics by door-to-needle time groups , they were fully adjusted for in the study, and in-hospital clustering was accounted for using robust variance estimation.
Source: JAMA - Category: General Medicine Source Type: research