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Search All Research Studies
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- Access to Care (1)
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- (-) Emergency Medical Services (EMS) (12)
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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 12 of 12 Research Studies DisplayedUrdaneta A, Fisk C, Tandel MD
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
This study examined patterns of air transport for acute ischemic stroke patients over a period of 8 years (2007-2014). The authors abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). They analyzed data from 149,751 hospitalized stroke patients who had a mean age of 81.6 years (standard deviation = 8.0 years), 62.1% female (n = 93,007), and 86.3% White (n = 129,268). Of these, 3.7% used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68 and OR = 0.34, respectively) and all racial minorities except American Natives (OR = 2.07) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23) and rural residents (OR = 1.34). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57).
AHRQ-funded; HS026207.
Citation: Urdaneta A, Fisk C, Tandel MD .
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
Air Med J 2023 Nov-Dec; 42(6):423-28. doi: 10.1016/j.amj.2023.06.007..
Keywords: Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Mihandoust S, Joseph A, Madathil KC
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
This study investigated the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Thirteen simulated telemedicine-based stroke consults were video recorded and then coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. Factors that impacted disruptions included seat size, arrangement of assessment equipment, location of telemedicine equipment, and design of the telemedicine camera. The left ambulance seat zone and head of the patient bed had more environmental hazard-related disruptions, while the right zone was more prone to interruptions and communication-related disruptions.
AHRQ-funded; HS026809.
Citation: Mihandoust S, Joseph A, Madathil KC .
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
HERD 2022 Apr;15(2):96-115. doi: 10.1177/19375867211054759..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Glober N, Supples M, Persaud S
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
This paper describes the outcomes of a pilot study that used novel emergency medical services (EMS) protocol to expedite transfer of patients with large vessel occlusions (LVOs) to a comprehensive stroke center (CSC). The pilot study took place from Oct. 1, 2020 to Feb. 22, 2021 with Indianapolis EMS providers. In patients with possible LVO, the providers remained at the bedside until the clinical assessment and CT angiography were complete. This 5-month mixed methods study measured case-control assessment of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergency transfers via conventional interfacility transfer agencies. The protocol was used 42 times during the study period, with four patients found to have LVOs and transferred to a CSC. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes compared to 314.5 minutes for acute non-stroke transfers during the same period.
AHRQ-funded; HS026390.
Citation: Glober N, Supples M, Persaud S .
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
PLoS One 2022 Feb;17(2):e0264539. doi: 10.1371/journal.pone.0264539..
Keywords: Emergency Medical Services (EMS), Stroke, Cardiovascular Conditions, Critical Care
Rogers H, Madathil KC, Joseph A
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
This study investigates the impact of telemedicine on workload, teamwork, workflow, and communication of geographically distributed caregivers delivering stroke care in ambulance-based telemedicine. Simulated stroke sessions were conducted with selected caregivers, then followed with a survey and interviews. Findings showed that barriers included frustration with equipment, the loss of personal connection of the neurologists with the patients, and physical constraints in the ambulance. Facilitators included live visual communication increasing teamwork and efficiency, the ease of access to neurologist, increased flexibility, and high overall satisfaction and usability.
AHRQ-funded; HS026809.
Citation: Rogers H, Madathil KC, Joseph A .
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
Appl Ergon 2021 Nov;97:103537. doi: 10.1016/j.apergo.2021.103537..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Kass-Hout T, Lee J, Tataris K
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
This study’s objective was to evaluate the association of a regional prehospital transport policy that directly triages patients with suspected large vascular occlusion (LVO) stroke to the nearest comprehensive stroke center with rates of endovascular therapy (EVT). This retrospective, multicenter preimplementation-postimplementation study used an interrupted time series analysis to compare treatment rates before and after implementation in patients with acute ischemic stroke (AIS) arriving at 15 primary stroke centers and 8 comprehensive stroke centers in Chicago, Illinois, via emergency medical services (EMS) transport from December 1, 2017, to May 31, 2019. Among 7709 individuals with stroke, 663 with AIS arrived within 6 hours of stroke onset by EMS transport. The EVT rate increased overall among patients with AIS postimplementation and among EMS-transported patients with AIS within 6 hours of onset. There were no differences in EVT rates in patients not arriving by EMS within the 6- to 24-hour window or by interhospital transfer or walk-in.
AHRQ-funded; HS025359.
Citation: Kass-Hout T, Lee J, Tataris K .
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
JAMA Neurol 2021 Oct;78(10):1220-27. doi: 10.1001/jamaneurol.2021.2485..
Keywords: Stroke, Cardiovascular Conditions, Critical Care, Emergency Medical Services (EMS)
Mayampurath A, Parnianpour Z, Richards CT
Improving prehospital stroke diagnosis using natural language processing of paramedic reports.
Accurate prehospital diagnosis of stroke by emergency medical services (EMS) can increase treatments rates, mitigate disability, and reduce stroke deaths. IN this study, the investigators aimed to develop a model that utilized natural language processing of EMS reports and machine learning to improve prehospital stroke identification. The investigators conducted a retrospective study of patients transported by the Chicago EMS to 17 regional primary and comprehensive stroke centers.
AHRQ-funded; HS025359; HS027264.
Citation: Mayampurath A, Parnianpour Z, Richards CT .
Improving prehospital stroke diagnosis using natural language processing of paramedic reports.
Stroke 2021 Aug;52(8):2676-79. doi: 10.1161/strokeaha.120.033580..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality, Health Information Technology (HIT), Emergency Medical Services (EMS)
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Ali A, Zachrison KS, Eschenfeldt PC
Optimization of prehospital triage of patients with suspected ischemic stroke.
Prehospital routing algorithms for patients with suspected stroke because of large vessel occlusions should account for likelihood of benefit from endovascular therapy (EVT), risk of alteplase delays, and transport times. In this study, the investigators present a mathematical decision model that determines ideal prehospital routing recommendations for patients with suspected stroke because of large vessel occlusions, with consideration of patient characteristics and location at onset.
AHRQ-funded; HS024561.
Citation: Ali A, Zachrison KS, Eschenfeldt PC .
Optimization of prehospital triage of patients with suspected ischemic stroke.
Stroke 2018 Oct;49(10):2532-35. doi: 10.1161/strokeaha.118.022041..
Keywords: Emergency Medical Services (EMS), Stroke
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Hodell E, Hughes SD, Corry M
Paramedic perspectives on barriers to prehospital acute stroke recognition.
The researchers aimed to understand systematically the challenges and barriers faced by paramedics in recognizing stroke presentations in the field. They concluded that while challenges to stroke recognition in the field were slightly different for rural and urban emergency medical service providers, participants concurred that timely, systematic feedback on individual patients and case-based training would strengthen early stroke recognition skills.
AHRQ-funded; HS017965.
Citation: Hodell E, Hughes SD, Corry M .
Paramedic perspectives on barriers to prehospital acute stroke recognition.
Prehosp Emerg Care 2016 May-Jun;20(3):415-24. doi: 10.3109/10903127.2015.1115933.
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Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Healthcare Delivery, Stroke, Training
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