Abstract
BACKGROUND: Reducing time to intravenous thrombolysis (IVT) is crucial for effective ischemic stroke treatment. Through grassroots efforts, the FSR (Florida Stroke Registry) developed regional dashboards (RDs) displaying reperfusion metrics within local Stroke Coalitions to improve acute stroke care quality. We sought to evaluate whether RD use is associated with faster IVT times and improved hospitalization outcomes. METHODS: We compared IVT-treated cases of ischemic stroke at FSR hospitals participating in the RD initiative versus nonparticipating hospitals from January 2016 to December 2023. Primary outcomes were door-to-treatment time <20 minutes and onset-to-treatment time <60 minutes. Secondary outcomes included intracerebral hemorrhage after IVT, discharge disposition, and in-hospital death. Logistic regression models, adjusted for calendar year, patient characteristics, and hospital factors, assessed the association between RD use and study outcomes. RESULTS: By the end of the study period, 92 of 172 FSR hospitals (53.5%) were participating in stroke coalitions and using RDs. Among 32 320 IVT-treated cases (mean age, 69±15 years, 48.4% women), 10 666 (33.0%) were treated in RD-participating hospitals. RD participation was independently associated with door-to-treatment time <20 minutes (12.7% versus 7.3%; adjusted odds ratio, 1.48 [95% CI, 1.35-1.63]) and onset-to-treatment time <60 minutes (13.9% versus 9.0%; adjusted odds ratio, 1.63 [95% CI, 1.49-1.80]), as well as increased likelihood of being discharged directly to home (adjusted odds ratio, 1.15 [95% CI, 1.07-1.23]). CONCLUSIONS: The implementation of the FSR RD initiative within stroke coalitions was associated with faster IVT times and higher likelihood of home discharge. This quality improvement initiative, adaptable to local needs, could emerge as a valuable tool for enhancing stroke systems of care.