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  • 1
    Online Resource
    Online Resource
    Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity
    American Medical Association (AMA) ; 2012
    In:  JAMA Vol. 308, No. 3 ( 2012-07-18)
    Details
    In: JAMA, American Medical Association (AMA), Vol. 308, No. 3 ( 2012-07-18)
    Type of Medium: Online Resource
    ISSN: 0098-7484
    URL: Article
    DOI: 10.1001/jama.2012.7870
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2012
    detail.hit.zdb_id: 2958-0
    detail.hit.zdb_id: 2018410-4
    SSG: 5,21
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  • 2
    Online Resource
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    Racial/Ethnic Differences in Process of Care and Outcomes Among Patients Hospitalized With Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 11 ( 2014-11), p. 3243-3250
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 11 ( 2014-11), p. 3243-3250
    Abstract: Although racial/ethnic differences in care are pervasive in many areas of medicine, little is known whether intracerebral hemorrhage (ICH) care processes or outcomes differ by race/ethnicity. Methods— We analyzed 123 623 patients with ICH (83 216 white, 22 147 black, 10 519 Hispanic, and 7741 Asian) hospitalized at 1199 Get With The Guidelines-Stroke hospitals between 2003 and 2012. Multivariable logistic regression with generalized estimating equation was used to evaluate the association among race, stroke performance measures, and in-hospital outcomes. Results— Relative to white patients, black, Hispanic, and Asian patients were significantly younger, but more frequently had more severe stroke (median National Institutes of Health Stroke Scale, 9, 10, 10, and 11, respectively; P 〈 0.001). After adjustment for both patient and hospital-level characteristics, black patients were more likely to receive deep venous thrombosis prophylaxis, rehabilitation assessment, dysphagia screening, and stroke education, but less likely to have door to computed tomographic time ≤25 minutes and smoking cessation counseling than whites. Both Hispanic and Asian patients had higher odds of dysphagia screening but lower odds of smoking cessation counseling. In-hospital all-cause mortality was lower for blacks (23.0%), Hispanics (22.8%), and Asians (25.3%) than for white patients (27.6%). After risk adjustment, all minority groups had lower odds of death, of receiving comfort measures only or of being discharged to hospice. In contrast, they were more likely to exceed the median length of stay when compared with white patients. Conclusions— Although individual quality indicators in ICH varied by race/ethnicity, black, Hispanic, and Asian patients with ICH had lower risk-adjusted in-hospital mortality than white patients with ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.114.005620
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 5 ( 2016-05), p. 1294-1302
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 5 ( 2016-05), p. 1294-1302
    Abstract: Get With The Guidelines (GWTG)-Stroke is a national, hospital-based quality improvement program developed by the American Heart Association. Although studies have suggested improved processes of care in GWTG-Stroke–participating hospitals, it is not known whether this improved care translates into improved clinical outcomes compared with nonparticipating hospitals. Methods— From all acute care US hospitals caring for Medicare beneficiaries with acute stroke between April 2003 and December 2008, we matched hospitals that joined the GWTG-Stroke program with similar hospitals that did not. Using a difference-in-differences design, we analyzed whether hospital participation in GWTG-Stroke was associated with a greater improvement in clinical outcomes compared with the underlying secular change. Results— The matching algorithm identified 366 GWTG-Stroke–adopting hospitals that cared for 88 584 acute ischemic stroke admissions and 366 non–GWTG-Stroke hospitals that cared for 85 401 acute ischemic stroke admissions. Compared with the Pre period (18–6 months before program implementation), in the Early period (0–6 months after program implementation), GWTG-Stroke hospitals had accelerated increases in discharge to home and reduced mortality at 30 days and 1 year. In the Sustained period (6–18 months after program implementation), the accelerated reduction in mortality at 1 year was sustained, with a trend toward sustained accelerated increase in discharge home. Conclusions— Hospital adoption of the GWTG-Stroke program was associated with improved functional outcomes at discharge and reduced postdischarge mortality.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011874
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 4
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    The “Golden Hour” and Acute Brain Ischemia : Presenting Features and Lytic Therapy in 〉30 000 Patients Arriving Within 60 Minutes of Stroke Onset
    Ovid Technologies (Wolters Kluwer Health) ; 2010
    In:  Stroke Vol. 41, No. 7 ( 2010-07), p. 1431-1439
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 7 ( 2010-07), p. 1431-1439
    Abstract: Background and Purpose— The benefit of intravenous thrombolytic therapy in acute brain ischemia is strongly time dependent. Methods— The Get With the Guidelines–Stroke database was analyzed to characterize ischemic stroke patients arriving at hospital Emergency Departments within 60 minutes of the last known well time from April 1, 2003, to December 30, 2007. Results— During the 4.75-year study period, among 253 148 ischemic stroke patients arriving directly by ambulance or private vehicle at 905 hospital Emergency Departments, 106 924 (42.2%) had documented, exact last known well times. Onset to door time was ≤60 minutes in 30 220 (28.3%), 61 to 180 minutes in 33 858 (31.7%), and 〉 180 minutes in 42 846 (40.1%). Features most strongly distinguishing the patients arriving at ≤60, 61 to 180, and 〉 180 minutes were greater stroke severity (median National Institutes of Health Stroke Scale score, 8.0 vs 6.0 vs 4.0, P 〈 0.0001) and more frequent arrival by ambulance (79.0%. vs 72.2% vs 55.0%, P 〈 0.0001). Compared with patients arriving at 61 to 180 minute, “golden hour” patients received intravenous thrombolytic therapy more frequently (27.1% vs 12.9%; odds ratio=2.51; 95% CI, 2.41–2.61; P 〈 0.0001), but door-to-needle time was longer (mean, 90.6 vs 76.7 minutes, P 〈 0.0001). A door-to-needle time of ≤60 minutes was achieved in 18.3% of golden hour patients. Conclusions— At Get With the Guidelines-Stroke hospital Emergency Departments, more than one quarter of patients with documented onset time and at least one eighth of all ischemic stroke patients arrived within 1 hour of onset, where they received thrombolytic therapy more frequently but more slowly than late arrivers. These findings support public health initiates to increase early presentation and shorten door-to-needle times in patients arriving within the golden hour.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.110.583815
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2010
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Stroke Quality Metrics : Systematic Reviews of the Relationships to Patient-Centered Outcomes and Impact of Public Reporting
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. 1 ( 2012-01), p. 155-162
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. 1 ( 2012-01), p. 155-162
    Abstract: Stroke quality metrics play an increasingly important role in quality improvement and policies related to provider reimbursement, accreditation, and public reporting. We conducted 2 systematic reviews examining the relationships between compliance with stroke quality metrics and patient-centered outcomes, and public reporting of stroke metrics and quality improvement, quality of care, or outcomes. Methods— MEDLINE and EMBASE databases were searched to identify studies that evaluated the relationship between stroke quality metric compliance and patient-centered outcomes in acute hospital settings and public reporting of stroke quality metrics and quality improvement activities, quality of care, or patient outcomes. We specifically excluded studies that evaluated the effect of stroke units or hospital certification. Results— Fourteen studies met eligibility criteria for the review of stroke quality metric compliance and patient-centered outcomes; 9 found mostly positive associations, whereas 5 found no or very limited associations. Only 2 eligible studies were found that directly addressed the public reporting of stroke quality metrics. Conclusions— Some studies have found positive associations between stroke metric compliance and improved patient-centered outcomes. However, high-quality studies are lacking and several methodological difficulties make the interpretation of the reported associations challenging. Information on the impact of public reporting of stroke quality metric data is extremely limited. Legitimate questions remain as to whether public reporting of stroke metrics is accurate, effective, or has the potential for unintended consequences. The generation of high-quality data examining quality metrics and stroke outcomes as well as the impact of public reporting should be given priority.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.635011
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Outcomes in Mild or Rapidly Improving Stroke Not Treated With Intravenous Recombinant Tissue-Type Plasminogen Activator : Findings From Get With The Guidelines–Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Stroke Vol. 42, No. 11 ( 2011-11), p. 3110-3115
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 11 ( 2011-11), p. 3110-3115
    Abstract: Mild or rapidly improving stroke is a frequently cited reason for not giving intravenous recombinant tissue-type plasminogen activator (rtPA), but some of these patients may have poor outcomes. We used data from a large nationwide study (Get With The Guidelines–Stroke) to determine risk factors for poor outcomes after mild or improving stroke at hospital discharge. Methods— Between 2003 and 2009, there were 29 200 ischemic stroke patients (from 1092 hospitals) arriving within 2 hours after symptom onset with mild or rapidly improving stroke symptoms as the only contraindication to rtPA. Logistic regression was used to determine the independent predictors of discharge to home. Results— Among 93 517 patients arriving within 2 hours, 31.2% (29 200) did not receive rtPA solely because of mild/improving stroke. Among the 29 200 mild/improving cases, 28.3% were not discharged to home, and 28.5% were unable to ambulate without assistance at hospital discharge. The likelihood of home discharge was strongly related to initial National Institutes of Health Stroke Scale score ( P 〈 0.001). In multivariable-adjusted analysis, patients not discharged to home were more likely to be older, female, and black; have a higher National Institutes of Health Stroke Scale score and vascular risk factors; and were less likely to be taking lipid-lowering medication before admission. Conclusions— In this large, nationwide study, a sizeable minority of patients who did not receive intravenous rtPA solely because of mild/improving stroke had poor short-term outcomes, raising the possibility that stroke-related disability is relatively common, even in “mild” stroke. A controlled trial of reperfusion therapy in this population may be warranted.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.613208
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Ischemic Stroke Systems of Care in California: Evolution in the Organization During the Mechanical Thrombectomy Era
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke: Vascular and Interventional Neurology Vol. 2, No. 5 ( 2022-09)
    Details
    In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 5 ( 2022-09)
    Abstract: Optimized stroke systems of care enable access to timely care, including endovascular thrombectomy (EVT). Stroke systems have likely evolved after publication of EVT benefit (2015). Our objective was to map the stroke patient transfer network in California in terms of EVT access and patient transfer patterns, and to examine changes after 2015. Methods In this observational study, we identified all ischemic stroke encounters, transfers, alteplase use, and EVT procedures in California from 2010 to 2017. An established connection between any hospital pair was defined as the transfer of ≥2 patients between them. A 2‐level logistic regression model assessed whether encounters were more frequently transferred to EVT‐capable hospitals post‐2015, adjusting for patient‐ and hospital‐level factors. Linear regression examined trends in key network characteristics over time, and interrupted time series regressions examined for changes post‐2015. Results Among 336 247 encounters, 3.4% were transferred, 9.3% received alteplase, and 2.3% underwent EVT. From 2010 to 2017 the proportion that were EVT treated increased (1.0%–4.3%; P ‐for‐trend 〈 0.001) with a significant increase post‐2015 ( P =0.01). Odds of transfer to EVT‐capable hospital were greater post‐2015 (adjusted odds ratio, 6.54; [95% CI 5.52–7.74]), but were lower for patients who were older, Black, Hispanic, and presented to a rural hospital. Significant network changes from 2010 to 2017 included increased number of encounters transferred, increased number of transferring hospitals, decreasing number of receiving hospitals, and increased proportion of receiving hospitals performing EVT. However, none of these network changes demonstrated a significant inflection point after 2015. Conclusion The California stroke network has been dynamic over time. Although most changes have been incremental, after the release of EVT trial data in 2015 changes in transfer patterns did lead to increased access to EVT.
    Type of Medium: Online Resource
    ISSN: 2694-5746
    URL: Article
    DOI: 10.1161/SVIN.121.000206
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 3144224-9
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  • 8
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    A Risk Score for In‐Hospital Death in Patients Admitted With Ischemic or Hemorrhagic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Journal of the American Heart Association Vol. 2, No. 1 ( 2013-01-23)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 1 ( 2013-01-23)
    Abstract: We aimed to derive and validate a single risk score for predicting death from ischemic stroke ( IS ), intracerebral hemorrhage ( ICH ), and subarachnoid hemorrhage ( SAH ). Methods and Results Data from 333 865 stroke patients ( IS , 82.4%; ICH , 11.2%; SAH , 2.6%; uncertain type, 3.8%) in the G et W ith T he G uidelines— S troke database were used. In‐hospital mortality varied greatly according to stroke type ( IS , 5.5%; ICH , 27.2%; SAH , 25.1%; unknown type, 6.0%; P 〈 0.001). The patients were randomly divided into derivation (60%) and validation (40%) samples. Logistic regression was used to determine the independent predictors of mortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale ( NIHSS ) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS . The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. Conclusions A single prediction score for all stroke types can be used to predict risk of in‐hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.112.005207
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2653953-6
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  • 9
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    Trends in Use, Outcomes, and Disparities in Endovascular Thrombectomy in US Patients With Stroke Aged 80 Years and Older Compared With Younger Patients
    American Medical Association (AMA) ; 2022
    In:  JAMA Network Open Vol. 5, No. 6 ( 2022-06-07), p. e2215869-
    Details
    In: JAMA Network Open, American Medical Association (AMA), Vol. 5, No. 6 ( 2022-06-07), p. e2215869-
    Type of Medium: Online Resource
    ISSN: 2574-3805
    URL: Article
    DOI: 10.1001/jamanetworkopen.2022.15869
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
    detail.hit.zdb_id: 2931249-8
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  • 10
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    Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of the American Heart Association Vol. 9, No. 1 ( 2020-01-07)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 9, No. 1 ( 2020-01-07)
    Abstract: We aimed to determine if there is an association between hospital quality and the likelihood of a given hospital being a preferred transfer destination for stroke patients. Methods and Results Data from Medicare claims identified acute ischemic stroke transferred between 394 northeast US hospitals from 2007 to 2011. Hospitals were categorized as transferring (n=136), retaining (n=241), or receiving (n=17) hospitals based on the proportion of acute ischemic stroke encounters transferred or received. We identified all 6409 potential dyads of sending and receiving hospitals, and categorized dyads as connected if ≥5 patients were transferred between the hospitals annually (n=82). We used logistic regression to identify hospital characteristics associated with establishing a connected dyad, exploring the effect of adjusting for different quality measures and outcomes. We also adjusted for driving distance between hospitals, receiving hospital stroke volume, and the number of hospitals in the receiving hospital referral region. The odds of establishing a transfer connection increased when rate of alteplase administration increased at the receiving hospital or decreased at the sending hospital, however this finding did not hold after applying a potential strategy to adjust for clustering. Receiving hospital performance on 90‐day home time was not associated with likelihood of transfer connection. Conclusions Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.118.011575
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2653953-6
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