---is the largest ever stroke database. A report on the first million stroke admissions appeared in Circulation: Cardiovascular Quality and Outcomes. The report is open access full text and is important for these reasons:
It is the largest database of its kind.
The process improvement tools and learning resources embedded in the project resulted in robust increases in guideline adherent care.
Although the cause and effect relationship is uncertain, improved guideline adherence was associated with reduced mortality and length of stay.
The report suffers from the unfortunate use of the term performance. This was a guideline adherence initiative more than a performance initiative in that it did not involve public report cards, reports to CMS or reports to Joint Commission.