Abstract 5623: Early Antithrombotic Therapy Performance Measure in Ischemic Stroke and Clinical Outcomes
Bibliographic record
Abstract
Background: Guidelines recommend that patients hospitalized with ischemic stroke should receive antithrombotic therapy within 48 hours of symptom onset to reduce stroke mortality and morbidity. An early antithrombotic process of care measure is being considered by the Center for Medicare and Medicaid Services (CMS). However, it is unknown if this process of care measure is associated with outcomes in routine clinical practice and provides discrimination of the quality of stroke care provided at the hospital level. Methods: We analyzed data from 91,184 Medicare fee-for-service beneficiaries enrolled from 625 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006, which were linked to outcome data from CMS. The process measure assessed was the % of patients with ischemic stroke who received antithrombotic (antiplatelet or anticoagulant) therapy by the end of hospital day two in the absence of IV tPA and as long as no contraindications existed. Cox proportional hazards models were used to estimate the unadjusted and adjusted association of this process measure with 30-day mortality. Results: Mean age was 79.3 years, 58% were female, and 32% had prior stroke/TIA. The median hospital conformity rate was 93.8% (25 th -75 th , 90.3–96.7%) for this measure. The 30-day mortality rate (measured from hospital day 2) in this cohort was 13.1%. The adjusted odds ratio for 30-day mortality with a 10% increase in adherence at the hospital level was 0.91, 95% CI 0.87– 0.96, P=0.0005. Conclusions: An early antithrombotic therapy performance measure in eligible ischemic stroke patients is associated with improved 30-day outcomes, discriminates quality of care for ischemic stroke, and may be considered a useful clinical performance measure. This research has received full or partial funding support from the American Heart Association, National Center.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".