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

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.