Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit Ying Xian, MD, PhD, a Gregg C. Fonarow, MD, b Mathew J. Reeves, PhD, c Laura E. Webb, CCRP, a Jason Blevins, MPH, a Vladimir S. Demyanenko, MS, a Xin Zhao, MS, a DaiWai M. Olson, PhD, RN, a Adrian F. Hernandez, MD, MHS, a Eric D. Peterson, MD, MPH, a Lee H. Schwamm, MD, d and Eric E. Smith, MD, MPH e Durham, NC; Los Angeles, CA; East Lansing, MI; Boston, MA; and Alberta, Canada Background Get With The Guidelines (GWTG)-Stroke is a national stroke registry and quality improvement program. We examined the accuracy and reliability of data entered in GWTG-Stroke. Methods Data entered by sites in the GWTG-Stroke database were compared with that abstracted from de-identified medical records by trained auditors. Accuracy for each individual data element and a composite accuracy measure were calculated. Reliability was assessed using kappa (κ) statistics for categorical variables and intraclass correlation (ICC) for continuous variables. Results A random selection of 438 medical records from 147 GWTG-Stroke hospitals was obtained. Overall accuracy was above 90% for all variables abstracted except for weight (84.9%), serum creatinine (88.1%), deep venous thrombosis prophylaxis (79.0%), and date/time last known well (85.3%). Intermediate to good (κ or ICC 0.40-0.75) or excellent agreement (κ or ICC ≥0.75) was observed for nearly all audited variables, including time-related performance measures such as arrival within 2 hours of symptom onset (κ = 0.90) and door-to-needle time ≤60 minutes (κ = 0.72). The overall composite accuracy rate was 96.1%. The composite measure varied slightly by region and hospital academic status, but there were no significant differences in composite accuracy by bed size, ischemic stroke volume, primary stroke center certification, or Coverdell Registry participation. Conclusions This audit establishes the reliability of GWTG-Stroke registry data. Individual data elements with suboptimal accuracy should be targeted for further data quality improvement. (Am Heart J 2012;163:392-398.e1.) Stroke is a leading cause of serious long-term dis- ability and the fourth leading cause of mortality in the United States. 1 Despite the wide dissemination of evidence-based guidelines, 2,3 many patients with stroke do not receive recommended therapies. 4,5 The Get With The Guidelines (GWTG)-Stroke program is a national stroke registry and performance improvement program developed by the American Heart Association and the American Stroke Association (AHA/ASA) to promote stroke quality improvement efforts, reduce disparities in stroke care, and improve clinical outcomes through increased adherence to guideline recommenda- tions. 6-8 During the last decade, dramatic improvement in multiple processes of care has been documented in the GWTG-Stroke program. 7 Nevertheless, participation in GWTG-Stroke is volun- tary. Hospitals participate based on their level of inte- rest in stroke quality improvement and their capacity to fulfill the requirements. Similar to the Paul Coverdell National Acute Stroke Registry and the Joint Commis- sion's Primary Stroke Center Certification Program, the GWTG-Stroke registry relies on user-reported data. Collectively, more than 2 million stroke admissions have been captured in these registries. However, published data on the accuracy and reliability of these user-submitted data are limited. 9 Therefore, it is impor- tant to evaluate the quality of data submitted by participating hospitals and judge the reliability of the From the a Duke Clinical Research Institute, Durham, NC, b Division of Cardiology, University of California, Los Angeles, CA, c Department of Epidemiology, Michigan State University, East Lansing, MI, d Department of Neurology, Massachusetts General Hospital, Boston, MA, and e Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada. John S. Rumsfeld, MD, PhD served as guest editor for this article. Submitted September 15, 2011; accepted December 20, 2011. Reprint requests: Ying Xian, MD, PhD, Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705. E-mail: ying.xian@dm.duke.edu 0002-8703/$ - see front matter © 2012, Mosby, Inc. All rights reserved. doi:10.1016/j.ahj.2011.12.012