# Public Reporting of Quality and Clinical Outcomes in the Get With The Guidelines–Stroke Registry

## TL;DR

Hospitals participating in a public reporting program were more likely to follow stroke care guidelines, but patient outcomes were similar to nonparticipating hospitals.

## Contribution

This study evaluates the impact of voluntary public reporting on stroke care quality and clinical outcomes using a large national registry.

## Key findings

- Patients at public reporting hospitals were more likely to receive guideline-based care.
- Clinical outcomes like independent ambulation and mortality were similar between reporting and nonreporting hospitals.
- High-volume and high-performing hospitals were more likely to participate in public reporting.

## Abstract

What is the association of hospital participation in a quality registry voluntary public reporting program with quality of care and clinical outcomes?

In this cohort study of 501 763 patients at 2423 hospitals participating in the Get With The Guidelines–Stroke registry, 65.3% of hospitals were participating in voluntary public reporting 2 years after the start of the program. Patients at participating hospitals were more likely to receive guideline-based care compared with those at nonparticipating hospitals, although clinical outcomes were similar.

These findings suggest that patients at public reporting hospitals may be more likely to receive guideline-based care; more research is needed to determine whether public reporting could improve outcomes.

This cohort study evaluates whether voluntary public reporting among Get With The Guidelines (GWTG)–Stroke hospitals is associated with quality of care and clinical outcomes.

Public reporting of outcomes increases transparency. Research on the association between public reporting programs and quality of care and outcomes is needed.

To evaluate whether hospital voluntary participation in the Get With The Guidelines (GWTG)–Stroke public reporting program is associated with quality of care and clinical outcomes.

This cohort study used GWTG-Stroke registry data from January 1 to December 31, 2021. Clinical characteristics associated with hospital participation in public reporting were identified, and differences in patient quality of care and outcomes were compared between hospitals that participated in public reporting of outcomes and those that did not. The primary data analysis was completed on December 27, 2024, and revised November 15, 2025.

Hospital participation in public reporting.

The primary quality metric was defect-free care, a composite of 7 ischemic stroke quality measures (intravenous thrombolysis for patients arriving by 3.5 hours and treated by 4.5 hours, early antithrombotic use within 48 hours of admission, venous thromboembolism prophylaxis, antithrombotics at hospital discharge, anticoagulation for atrial fibrillation or flutter, smoking cessation counseling, and intensive statin therapy at discharge). Component measures were evaluated as secondary outcomes. The primary clinical outcome was independent ambulation at discharge. Secondary clinical outcomes included discharge to home, in-hospital mortality, and a composite of in-hospital mortality or discharge to hospice. Associations were measured using multivariable models adjusted for patient- and hospital-level variables.

There were 501 763 patients admitted for acute ischemic stroke (mean [SD] age, 69.8 [3.8] years; mean [SD] male, 51.5% [10.3%]) at 2423 hospitals; 1582 hospitals (65.3%) participated in public reporting. High-volume hospitals (quartile 4 [highest] vs 1 [lowest]: adjusted odds ratio [OR], 2.07 [95% CI, 1.43-2.99]) and high-performing hospitals measured by 2018 GWTG-Stroke quality awards (silver or gold: OR, 3.32 [95% CI, 2.63-4.20]) were more likely to participate in public reporting. In fully adjusted models, patients treated at participating hospitals were more likely to receive defect-free care (OR, 1.31 [95% CI, 1.27-1.35]) and more likely to receive all 7 of the individual components of defect-free care, although absolute differences between groups were small. There were minor differences in independent ambulation at discharge (OR, 1.02 [95% CI, 1.01-1.04]) and the composite of in-hospital mortality or discharge to hospice (OR, 1.05 [95% CI, 1.02-1.08]). There were no differences in discharge to home or in-hospital mortality.

In this cohort study of hospitals in the GWTG-Stroke program in 2021, patients at hospitals participating in voluntary public reporting were more likely to receive guideline-based care but had similar clinical outcomes compared with patients at nonreporting hospitals. More research is needed to evaluate whether public reporting could improve clinical outcomes.