National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Arthritis (1)
- Blood Clots (1)
- Blood Pressure (1)
- Blood Thinners (1)
- Cardiovascular Conditions (9)
- Case Study (1)
- Comparative Effectiveness (2)
- Critical Care (2)
- Depression (1)
- Diagnostic Safety and Quality (2)
- Disparities (3)
- Education: Patient and Caregiver (1)
- Elderly (3)
- Emergency Medical Services (EMS) (1)
- Family Health and History (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Services Research (HSR) (1)
- Heart Disease and Health (5)
- Home Healthcare (1)
- Hospital Discharge (1)
- Imaging (3)
- Inpatient Care (1)
- Medication (3)
- Medication: Safety (1)
- Mortality (2)
- Outcomes (2)
- Patient-Centered Outcomes Research (3)
- Racial and Ethnic Minorities (7)
- Risk (5)
- Screening (1)
- Sex Factors (1)
- Shared Decision Making (3)
- Social Determinants of Health (1)
- (-) Stroke (27)
- U.S. Preventive Services Task Force (USPSTF) (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 27 Research Studies DisplayedLewis MW, Khodneva Y, Redmond N
The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.
The authors investigated the association between income-education groups and incident coronary heart disease (CHD) in a national prospective cohort study. They found that, for younger individuals, low income, regardless of education, was associated with higher risk of CHD; however, this was not observed for those 65 years of age or older.
AHRQ-funded; HS023009.
Citation: Lewis MW, Khodneva Y, Redmond N .
The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.
BMC Public Health 2015 Dec 29;15:1312. doi: 10.1186/s12889-015-2630-4.
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Keywords: Cardiovascular Conditions, Racial and Ethnic Minorities, Social Determinants of Health, Stroke
Darger B, Gonzales N, Banuelos RC
Outcomes of patients requiring blood pressure control before thrombolysis with tPA for acute ischemic stroke.
The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. The researchers observed no association between BP control and adverse outcomes in ischemic stroke patients undergoing thrombolysis.
AHRQ-funded; HS017586.
Citation: Darger B, Gonzales N, Banuelos RC .
Outcomes of patients requiring blood pressure control before thrombolysis with tPA for acute ischemic stroke.
West J Emerg Med 2015 Dec;16(7):1002-6. doi: 10.5811/westjem.2015.8.27859.
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Keywords: Blood Pressure, Stroke, Medication, Outcomes
Kerber KA, Meurer WJ, Brown DL
Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study.
The researchers estimated the ability of bedside information to risk stratify stroke in acute dizziness presentations. They found that in acute dizziness presentations, the combination of ABCD(2) score, general neurologic examination, and a specialized ocular motor examination has the capacity to risk-stratify acute stroke on MRI.
AHRQ-funded; HS018334; HS017690; HS022258.
Citation: Kerber KA, Meurer WJ, Brown DL .
Stroke risk stratification in acute dizziness presentations: a prospective imaging-based study.
Neurology 2015 Nov 24;85(21):1869-78. doi: 10.1212/wnl.0000000000002141..
Keywords: Stroke, Risk, Healthcare Utilization, Shared Decision Making
Yaghi S, Herber C, Willey JZ
Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits.
The researchers' aim was to identify predictors of MRI-positive stroke from the itemized NIHSS. They concluded that NIHSS score subsets predict diffusion-weighted imaging positivity in mild strokes, and the presence of neglect or visual field deficits on the NIHSS subsets is most likely to have an MRI correlate even in patients with low NIHSS.
AHRQ-funded; HS013852.
Citation: Yaghi S, Herber C, Willey JZ .
Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits.
J Neurol Sci 2015 Nov 15;358(1-2):221-5. doi: 10.1016/j.jns.2015.08.1548.
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Keywords: Diagnostic Safety and Quality, Imaging, Stroke
Aparicio HJ, Carr BG, Kasner SE
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
The researechers found that racial disparities in intravenous recombinant tissue plasminogen activator (rt-PA) use were not reduced by presentation to primary stroke centers (PSCs). Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
AHRQ-funded; HS018362; HS017960; HS013852.
Citation: Aparicio HJ, Carr BG, Kasner SE .
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
J Am Heart Assoc 2015 Oct 14;4(10):e001877. doi: 10.1161/jaha.115.001877.
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Keywords: Healthcare Delivery, Disparities, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Stroke
Siegler JE, Samai A, Albright KC
Factoring in factor VIII with acute ischemic stroke.
This review summarized the molecular role of factor VIII in thrombogenesis and its clinical use in the diagnosis and prognosis of acute ischemic stroke. It also discussed the utility of screening for serum factor VIII levels among patients at risk for, or those who have experienced, ischemic stroke.
AHRQ-funded; HS013852.
Citation: Siegler JE, Samai A, Albright KC .
Factoring in factor VIII with acute ischemic stroke.
Clin Appl Thromb Hemost 2015 Oct;21(7):597-602. doi: 10.1177/1076029615571630.
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Keywords: Stroke, Blood Clots, Cardiovascular Conditions
Kabra R, Cram P, Girotra S
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
The researchers sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with newly diagnosed AF in patients >65 years. They found that the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for preexisting co-morbidities.
AHRQ-funded; HS021992.
Citation: Kabra R, Cram P, Girotra S .
Effect of race on outcomes (stroke and death) in patients >65 years with atrial fibrillation.
Am J Cardiol 2015 Jul 15;116(2):230-5. doi: 10.1016/j.amjcard.2015.04.012..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities, Stroke, Mortality, Risk
Bates BE, Xie D, Kwong PL
Development and validation of prognostic indices for recovery of physical functioning following stroke: part 1.
The purpose of this study was to develop a prognostic index using Functional Independence Measure grades and stages that would enable clinicians to determine the likelihood of achieving a level of minimum assistance with physical functioning after a stroke. It concluded that by using a simple tool, clinicians can forecast the likelihood of recovery to or above the physical grade IV benchmark by the conclusion of rehabilitation services during the acute stroke hospitalization.
AHRQ-funded; HS018540.
Citation: Bates BE, Xie D, Kwong PL .
Development and validation of prognostic indices for recovery of physical functioning following stroke: part 1.
PM R 2015 Jul;7(7):685-98. doi: 10.1016/j.pmrj.2015.01.011..
Keywords: Stroke, Cardiovascular Conditions
Bates BE, Xie D, Kwong PL
Development and validation of prognostic indices for recovery of physical functioning following stroke: part 2.
The purpose of this study was to develop a prognostic index for achievement of modified independence (Functional Independence Measure grade VI) after completion of either comprehensive or consultative rehabilitation after stroke. It found that functional recovery to physical grade VI can be predicted on the basis of patients’ initial status after a stroke occurs and the type of rehabilitation services to be provided by using a simple scoring system.
AHRQ-funded; HS018540.
Citation: Bates BE, Xie D, Kwong PL .
Development and validation of prognostic indices for recovery of physical functioning following stroke: part 2.
PM R 2015 Jul;7(7):699-710. doi: 10.1016/j.pmrj.2015.01.012..
Keywords: Stroke, Cardiovascular Conditions
Reistetter TA, Kuo YF, Karmarkar AM
Geographic and facility variation in inpatient stroke rehabilitation: multilevel analysis of functional status.
This study examined geographic and facility variation in cognitive and motor functional outcomes after postacute inpatient rehabilitation in patients with stroke. Its findings suggest that variation in motor and cognitive function at discharge after postacute rehabilitation in patients with stroke is accounted for more by facility than geographic location.
AHRQ-funded; HS022134.
Citation: Reistetter TA, Kuo YF, Karmarkar AM .
Geographic and facility variation in inpatient stroke rehabilitation: multilevel analysis of functional status.
Arch Phys Med Rehabil 2015 Jul;96(7):1248-54. doi: 10.1016/j.apmr.2015.02.020..
Keywords: Stroke, Cardiovascular Conditions, Inpatient Care, Outcomes
Lyerly MJ, Albright KC, Boehme AK
Patient selection for drip and ship thrombolysis in acute ischemic stroke.
The authors sought to determine whether the population of their offsite stroke patients receiving thrombolysis differed from patients treated directly at their stroke center. Their results showed that a smaller proportion of blacks and older adults arrived at their center from other facilities, possibly reflecting differences in how patients are selected for thrombolysis and transferred to a higher level of care.
AHRQ-funded; HS013852.
Citation: Lyerly MJ, Albright KC, Boehme AK .
Patient selection for drip and ship thrombolysis in acute ischemic stroke.
South Med J 2015 Jul;108(7):393-8. doi: 10.14423/smj.0000000000000306.
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Keywords: Critical Care, Elderly, Stroke, Racial and Ethnic Minorities
Lin CB, Cox M, Olson DM
Perception versus actual performance in timely tissue plasminogen activation administration in the management of acute ischemic stroke.
The purpose of this study was to compare stroke teams’ perceptions of their performance against known metrics associated with tPA administration. It found that less than one-third (29.1 percent) of staff accurately identified their door-to-needle performance It concluded that hospitals often overestimate their ability to deliver timely tPA to treated patients.
AHRQ-funded; HS016964.
Citation: Lin CB, Cox M, Olson DM .
Perception versus actual performance in timely tissue plasminogen activation administration in the management of acute ischemic stroke.
J Am Heart Assoc 2015 Jul;4(7). doi: 10.1161/jaha.114.001298..
Keywords: Stroke, Comparative Effectiveness, Patient-Centered Outcomes Research, Medication
Sims M, Redmond N, Khodneva Y
Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study.
The authors examined the association of depressive symptoms with coronary heart disease (CHD) end points by race and income. They found that high depressive symptoms were associated with higher risk of CHD or revascularization for blacks but not whites.
AHRQ-funded; HS023009.
Citation: Sims M, Redmond N, Khodneva Y .
Depressive symptoms are associated with incident coronary heart disease or revascularization among blacks but not among whites in the Reasons for Geographical and Racial Differences in Stroke study.
Ann Epidemiol 2015 Jun;25(6):426-32. doi: 10.1016/j.annepidem.2015.03.014.
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Keywords: Depression, Disparities, Heart Disease and Health, Racial and Ethnic Minorities, Stroke
Solomon DH, Reed GW, Kremer JM
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
The researchers studied whether time-averaged disease activity in rheumatoid arthritis (RA) correlates with cardiovascular (CV) events. They found that reduced time-averaged disease activity in RA is associated with fewer CV events.
AHRQ-funded; HS018517.
Citation: Solomon DH, Reed GW, Kremer JM .
Disease activity in rheumatoid arthritis and the risk of cardiovascular events.
Arthritis Rheumatol 2015 Jun;67(6):1449-55. doi: 10.1002/art.39098.
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Keywords: Cardiovascular Conditions, Heart Disease and Health, Arthritis, Risk, Stroke
Ripley DC, Kwong PL, Vogel WB
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
This study examined the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke. It found that even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with inhospital mortality.
AHRQ-funded; HS018540.
Citation: Ripley DC, Kwong PL, Vogel WB .
How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
Med Care 2015 Jun;53(6):501-9. doi: 10.1097/mlr.0000000000000366..
Keywords: Stroke, Mortality, Access to Care
Wolff T, Fan T, Lewis P
AHRQ Author: Wolff T, Fan T
Screening for carotid artery stenosis.
This case study, based on recommendations of the U.S. Preventive Services Task Force, concerns a 65-year-old woman who presents for her yearly checkup. She walks one to two miles daily, is in generally good health, and has no significant cardiovascular history. Questions concern whether she should be screened for carotid artery stenosis, the accuracy of the different screening methods, and the benefits and harms of screening.
AHRQ-authored.
Citation: Wolff T, Fan T, Lewis P .
Screening for carotid artery stenosis.
Am Fam Physician 2015 May 15;91(10):717-8..
Keywords: U.S. Preventive Services Task Force (USPSTF), Elderly, Case Study, Screening, Stroke
Lauffenburger JC, Farley JF, Gehi AK
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
The researchers compared the effectiveness and safety of the new oral anticoagulant, dabigatran, with warfarin in clinical practice among a large nationally representative retrospective cohort of commercially insured patients in the United States. They found that compared with warfarin, dabigatran was associated with a lower risk of ischemic stroke or systemic embolism, hemorrhagic stroke, and acute myocardial infarction.
AHRQ-funded; HS023099.
Citation: Lauffenburger JC, Farley JF, Gehi AK .
Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.
J Am Heart Assoc 2015 Apr 10;4(4):e001798. doi: 10.1161/jaha.115.001798..
Keywords: Comparative Effectiveness, Blood Thinners, Patient-Centered Outcomes Research, Stroke, Heart Disease and Health
Mullen MT, Branas CC, Kasner SE
Optimization modeling to maximize population access to comprehensive stroke centers.
This report demonstrates how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of primary stroke centers into comprehensive stroke centers (CSCs). Optimal system simulation can be used to develop efficient care systems that maximize accessibility. Under optimal conditions, a large proportion of the US population will be unable to access a CSC within 60 minutes.
AHRQ-funded; HS013852; HS017960; HS010914.
Citation: Mullen MT, Branas CC, Kasner SE .
Optimization modeling to maximize population access to comprehensive stroke centers.
Neurology 2015 Mar 24;84(12):1196-205. doi: 10.1212/wnl.0000000000001390..
Keywords: Stroke, Access to Care, Health Services Research (HSR)
Friedant AJ, Gouse BM, Boehme AK
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
The authors sought to develop a simple scoring system for any hospital-acquired infection (HAI). Ranging from 0 to 7, the overall infection score consists of age 70 years or more, history of diabetes, and National Institutes of Health Stroke Scale score. Patients with an infection score of 4 or more were at 5 times greater odds of developing an infection. They concluded that, if validated in other populations, this score could assist providers in predicting infections after ischemic stroke.
AHRQ-funded; HS013852.
Citation: Friedant AJ, Gouse BM, Boehme AK .
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
J Stroke Cerebrovasc Dis 2015 Mar;24(3):680-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.014.
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Keywords: Shared Decision Making, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Risk, Stroke
Aycock DM, Kirkendoll KD, Coleman KC
Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise.
The authors compared modifiable risk factors, knowledge of stroke risk factors, perceived threat of stroke, perceived control of stroke, and exercise behaviors and intentions in African Americans with a family history of stroke (FHS) and those without a FHS. They found that family history of stroke was common among those studied; however, this fact did not translate into better understanding of stroke or better exercise behaviors and intentions. They recommended that more be done to identify African Americans with a FHS, especially those with multiple risk factors, in order to educate them about the significance of FHS while promoting lifestyle change and self-management.
AHRQ-funded; HS013852.
Citation: Aycock DM, Kirkendoll KD, Coleman KC .
Family history of stroke among African Americans and its association with risk factors, knowledge, perceptions, and exercise.
J Cardiovasc Nurs 2015 Mar-Apr;30(2):E1-6. doi: 10.1097/jcn.0000000000000125.
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Keywords: Education: Patient and Caregiver, Family Health and History, Racial and Ethnic Minorities, Risk, Stroke
Radecki RP, Azam A, Doshi PB
Iodinated contrast prior to thrombolysis was not associated with worse intracranial hemorrhage.
The investigators' objective was to assess relative incidence of clinical adverse effects between patients receiving, and not receiving, iodinated contrast prior to thrombolysis. They found that no consistent harms were observed in association with intravenous iodinated contrast prior to recombinant tissue-type plasminogen activator administration, concluding that it is reasonable to continue computed tomographic angiography prior to thrombolysis as clinically indicated.
AHRQ-funded; HS017586.
Citation: Radecki RP, Azam A, Doshi PB .
Iodinated contrast prior to thrombolysis was not associated with worse intracranial hemorrhage.
Acad Emerg Med 2015 Mar;22(3):259-63. doi: 10.1111/acem.12603.
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Keywords: Adverse Drug Events (ADE), Emergency Medical Services (EMS), Medication, Medication: Safety, Stroke
Govindarajan P, Friedman BT, Delgadillo JQ
Race and sex disparities in prehospital recognition of acute stroke.
The investigators examined prehospital provider recognition of stroke by race and sex. They found that correct prehospital recognition of stroke was lower among Hispanic patients, Asians, and others, when compared with non-Hispanic whites, and also in women compared with men. They concluded that significant disparities exist in prehospital stroke recognition.
AHRQ-funded; HS017965.
Citation: Govindarajan P, Friedman BT, Delgadillo JQ .
Race and sex disparities in prehospital recognition of acute stroke.
Acad Emerg Med 2015 Mar;22(3):264-72. doi: 10.1111/acem.12595.
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Keywords: Diagnostic Safety and Quality, Disparities, Racial and Ethnic Minorities, Sex Factors, Stroke
Prvu Bettger J, McCoy L, Smith EE
Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
The authors examined trends in discharge to inpatient rehabilitation facilities, skilled nursing facilities, home with home health, and home without services for patients with ischemic or hemorrhagic stroke at hospitals participating in Get With The Guidelines-Stroke. They found that four in 10 stroke patients are discharged home without postacute care services. They recommended further research to explain the shift in service use by type and its effect on outcomes.
AHRQ-funded; HS019479.
Citation: Prvu Bettger J, McCoy L, Smith EE .
Contemporary trends and predictors of postacute service use and routine discharge home after stroke.
J Am Heart Assoc 2015 Feb 23;4(2). doi: 10.1161/jaha.114.001038.
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Keywords: Critical Care, Hospital Discharge, Home Healthcare, Stroke
Schaefer PW, Souza L, Kamalian S
Limited reliability of computed tomographic perfusion acute infarct volume measurements compared with diffusion-weighted imaging in anterior circulation stroke.
The researchers tested whether thresholded computed tomographic cerebral blood flow (CT-CBF) and CT-cerebral blood volume (CT-CBV) maps are sufficiently accurate to substitute for diffusion-weighted imaging (DWI) for estimating the critically ischemic tissue volume. They found that the poor contrast:noise ratios of CT-CBV and CT-CBF compared with those of DWI result in large measurement error, make it problematic to substitute CTP for DWI in selecting individual acute stroke patients for treatment.
AHRQ-funded; HS011392.
Citation: Schaefer PW, Souza L, Kamalian S .
Limited reliability of computed tomographic perfusion acute infarct volume measurements compared with diffusion-weighted imaging in anterior circulation stroke.
Stroke 2015 Feb;46(2):419-24. doi: 10.1161/strokeaha.114.007117..
Keywords: Stroke, Imaging
Stein J, Bettger JP, Sicklick A
Use of a standardized assessment to predict rehabilitation care after acute stroke.
The purpose of this project was to pilot a formal assessment of rehabilitation needs that included standardized measures of function and sociodemographic factors known to influence referral and utilization of rehabilitation after an acute stroke. It concluded that one of the standardized measures of function, the Barthel Index, is easy to use and appears to distinguish patients who can return directly home versus those who require institution-based rehabilitation.
AHRQ-funded; HS019479.
Citation: Stein J, Bettger JP, Sicklick A .
Use of a standardized assessment to predict rehabilitation care after acute stroke.
Arch Phys Med Rehabil 2015 Feb;96(2):210-7. doi: 10.1016/j.apmr.2014.07.403..
Keywords: Stroke, Cardiovascular Conditions