Results of Stroke Registries The Paul Coverdell National Acute Stroke Registry Initial Results from Four Prototypes Mathew J. Reeves, PhD, Joseph P. Broderick, MD, Michael Frankel, MD, Kenneth A. LaBresh, MD, Lee Schwamm, MD, Charles J. Moomaw, PhD, Paul Weiss, PhD, Irene Katzan, MD, for The Paul Coverdell Prototype Registries Writing Group Background: This paper summarizes the experiences of the Paul Coverdell National Acute Stroke Registry first four prototype registries in Georgia (GA), Massachusetts (MA), Michigan (MI), and Ohio (OH), and includes information on their sampling design, case ascertain- ment, and data collection methods, as well as some key findings. Methods: Using a combination of different sampling methods, each prototype obtained a represen- tative statewide sample of hospitals. Acute stroke admissions were identified through prospective (MA, MI) or retrospective (GA, OH) methods. A common set of case definitions and data elements were used by each registry. Weighted site-specific frequencies and 95% confidence intervals were generated for each outcome. A summary estimate, representing a weighted average of the four site-specific estimates, was also calculated. Results: Of the total 6867 admissions, 1487 (21.6%) were from the GA registry, 1206 (17.6%) from MA, 2566 (37.4%) from MI, and 1608 (23.4%) from the OH prototype. Just less than 60% of admissions were ischemic strokes (site-specific estimates ranged from 52% to 70%), with transient ischemic attack (18.5%) and intracerebral hemorrhage (8.8%) making up most of the remainder. Twenty-one percent of patients admitted were younger than 60 years of age, and 55.3% were women. The proportion of black subjects varied from 7.1% (MI) to 30.6% (GA). Twenty-three percent of admissions arrived at the emergency department within 3 hours of onset. Overall 4.5% of ischemic stroke admissions were treated with recombinant tissue plasminogen activator; site-specific treatment rates were 3.0% (GA), 3.2% (OH), 3.4% ( MI), and 8.5% (MA). Only a small minority of treated patients (range, 10.8% [OH] to 19.6% [MI]) received recombinant tissue plasminogen activator within the recommended 1 hour door-to- needle time. A minority of eligible subjects were screened for dysphagia (45.4%), underwent lipid testing (33.6%), or received smoking-cessation counseling (21.4%). In contrast, compli- ance with antithrombotic treatments at discharge was high (91.5%). Conclusions: A minority of acute stroke patients are treated according to established guidelines. Quality improvement interventions, targeted primarily at the healthcare systems level, are needed to improve acute stroke care in the United States. (Am J Prev Med 2006;31(6S2):S202–S209) © 2006 American Journal of Preventive Medicine Introduction T he Paul Coverdell National Acute Stroke Registry (PCNASR) is designed to track the delivery of care to hospitalized stroke patients and to guide and monitor improvements in the quality of acute stroke care. The registry’s initial goals and content have been summa- rized elsewhere. 1 Eight prototype registries were funded to pilot test methods and quality improvement (QI) interventions. The first phase of this pilot testing involved four registries located in Georgia (GA), Massachusetts (MA), Michigan (MI), and Ohio (OH), which completed data collection by the end of 2002. Site-specific results from these prototypes have been published previously. 2 The purpose of this report is to provide a brief summary of the design, case-inclusion criteria, data collection, and several key findings (including demographics, acute care treatments, and selective stroke care performance indica- tors) from these four prototypes. Methods More detailed information on the development of the PCNASR and the design of the four initial prototypes can be found elsewhere. 1,2 From the Department of Epidemiology, Michigan State University (Reeves), East Lansing, Michigan; University of Cincinnati (Brod- erick, Moomaw), Cincinnati, Ohio; Emory University (Frankel, Weiss), Atlanta, Georgia; Massachusetts PRO (LaBresh), Boston, Massachusetts; Harvard University (Schwamm), Cambridge, Massa- chusetts; MetroHealth Medical Center and Cleveland Clinic Founda- tion (Katzan), Cleveland, Ohio Address correspondence and reprint requests to: Mathew J. Reeves, BVSc, PhD, Department of Epidemiology, B 601 West Fee Hall, Michigan State University, East Lansing MI 48824. E-mail: reevesm@msu.edu. S202 Am J Prev Med 2006;31(6S2) 0749-3797/06/$–see front matter © 2006 American Journal of Preventive Medicine • Published by Elsevier Inc. doi:10.1016/j.amepre.2006.08.007