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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
26 to 50 of 56 Research Studies DisplayedGadhia R, Schwamm LH, Viswanathan A
Evaluation of the experience of spoke hospitals in an academic telestroke network.
Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. In this study, the investigators sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use.
AHRQ-funded; HS024561.
Citation: Gadhia R, Schwamm LH, Viswanathan A .
Evaluation of the experience of spoke hospitals in an academic telestroke network.
Telemed J E Health 2019 Jul;25(7):584-90. doi: 10.1089/tmj.2018.0133..
Keywords: Telehealth, Health Information Technology (HIT), Hospitals, Stroke, Cardiovascular Conditions
Krishnan S, Hay CC, Pappadis MR
Stroke survivors' perspectives on post-acute rehabilitation options, goals, satisfaction, and transition to home.
This study analyzed stroke survivors’ perspectives on post-acute rehabilitation involvement with their care during discharge planning. Researchers interviewed eighteen stroke survivors who were sent to inpatient rehabilitation facilities after a stroke. They were surveyed about their involvement in decisions made in the selection of their rehabilitation facilities, and more than half were not. About two-thirds of patients were not involved in rehabilitation goal setting. However, most patients were satisfied with their rehabilitation stay.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Hay CC, Pappadis MR .
Stroke survivors' perspectives on post-acute rehabilitation options, goals, satisfaction, and transition to home.
J Neurol Phys Ther 2019 Jul;43(3):160-67. doi: 10.1097/npt.0000000000000281..
Keywords: Hospital Discharge, Rehabilitation, Stroke, Transitions of Care
Shah S, Xian Y, Olson DM
Home-time is a patient-centered outcome variable for stroke: an executive summary.
An outcome measure to assess functional recovery after stroke that is easily obtainable and meaningful to the patient can be very useful for assessing risks and benefits of therapeutic strategies. Home-time, which is defined as the total number of days spent alive by the patient at home, outside healthcare institutions after discharge from an index stroke event, is such a measure, and is discussed in this paper.
AHRQ-funded.
Citation: Shah S, Xian Y, Olson DM .
Home-time is a patient-centered outcome variable for stroke: an executive summary.
J Neurosci Nurs 2019 Jun;51(3):110-12. doi: 10.1097/jnn.0000000000000437..
Keywords: Patient-Centered Outcomes Research, Stroke, Cardiovascular Conditions, Outcomes
Colla CH, Lewis VA, Stachowski C
Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts.
In this study, researchers examined changes in more and less discretionary condition-specific postacute care use associated with Medicare accountable care organization (ACO) implementation. They found that ACOs decreased spending on postacute care by decreasing use of discretionary services. In addition, ACO implementation was associated with reduced length of stay in skilled nursing facilities, while hip fracture patients used institutional postacute settings at higher rates. The authors also observed decreases in spending, readmission days, and mortality among pneumonia patients.
AHRQ-funded; HS024698.
Citation: Colla CH, Lewis VA, Stachowski C .
Changes in use of postacute care associated with accountable care organizations in hip fracture, stroke, and pneumonia hospitalized cohorts.
Med Care 2019 Jun;57(6):444-52. doi: 10.1097/mlr.0000000000001121..
Keywords: Injuries and Wounds, Healthcare Costs, Healthcare Utilization, Hospitalization, Medicare, Pneumonia, Stroke
Kempker JA, Panwar B, Judd SE
Plasma 25-hydroxyvitamin d and the longitudinal risk of sepsis in the REGARDS cohort..
In this paper, researchers studied low baseline plasma 25-hydroxyvitamin D (25(OH)D) and its association with long-term risk of sepsis. Data from the Reasons for Geographic and Racial Differences in Stroke study was used. Findings reveals that, among community-dwelling US adults, low plasma 25(OH)D measured at a time of relative health was independently associated with increased risk of sepsis.
AHRQ-funded; HS025240.
Citation: Kempker JA, Panwar B, Judd SE .
Plasma 25-hydroxyvitamin d and the longitudinal risk of sepsis in the REGARDS cohort..
Clin Infect Dis 2019 May 17;68(11):1926-31. doi: 10.1093/cid/ciy794..
Keywords: Community-Acquired Infections, Racial and Ethnic Minorities, Risk, Sepsis, Stroke
Simon KC, Munson R, Ong A
Design and implementation of structured clinical documentation support tools for treating stroke patients.
This article describes the development of a customized structured clinical documentation toolkit that standardizes patient data collection to conform to Best Practices for treating patients with stroke. The toolkit collects demographic information for patients, relevant score test measures, and information on disability, treatment, and outcomes. Basic descriptive data gathered via the toolkits is provided and their utility in collecting patient data in a manner that supports both quality clinical care and research initiatives demonstrated. Quality improvement projects and current research initiatives using the toolkit are also discussed.
AHRQ-funded; HS024057.
Citation: Simon KC, Munson R, Ong A .
Design and implementation of structured clinical documentation support tools for treating stroke patients.
J Stroke Cerebrovasc Dis 2019 May;28(5):1229-35. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.011..
Keywords: Electronic Health Records (EHRs), Evidence-Based Practice, Guidelines, Health Information Technology (HIT), Stroke, Tools & Toolkits
Mahalingam M, Moore Jx, Donnelly JP
Frailty syndrome and risk of sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.
This study examined the association between frailty (weakness, exhaustion, and low physical activity) and the risk of sepsis in stroke patients. Data from the cohort study Reasons for Geographic and Racial Differences in Stroke (REGARDS) was used. There was an associated increase in sepsis hospitalizations and 30-day case fatalities from sepsis in stroke patients with more frailty indicators.
AHRQ-funded; HS013852.
Citation: Mahalingam M, Moore Jx, Donnelly JP .
Frailty syndrome and risk of sepsis in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort.
J Intensive Care Med 2019 Apr;34(4):292-300. doi: 10.1177/0885066617715251..
Keywords: Elderly, Racial and Ethnic Minorities, Risk, Sepsis, Stroke
Shah S, Xian Y, Sheng S
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
This study examined the use, trends and outcomes of endovascular therapy (EVT) after interhospital transfer in the United Sates. This cohort study analyzed trends from over 1.8 million patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between 2012 and 2017. There were differences in mortality for interhospital transfer patients, although those differences disappeared after adjusting for delay in EVT initiation.
AHRQ-funded; HS024561.
Citation: Shah S, Xian Y, Sheng S .
Use, temporal trends, and outcomes of endovascular therapy after interhospital transfer in the United States.
Circulation 2019 Mar 26;139(13):1568-77. doi: 10.1161/circulationaha.118.036509..
Keywords: Stroke, Cardiovascular Conditions, Transitions of Care, Outcomes, Healthcare Delivery, Hospitals, Mortality, Quality of Care
Trent SA, Morse EA, Ginde AA
Barriers to prompt presentation to emergency departments in Colorado after onset of stroke symptoms.
Despite significant morbidity and mortality from stroke, patient delays to emergency department (ED) presentation following the onset of stroke symptoms are one of the main contraindications to treatment for acute ischemic stroke (AIS). The objective of this study was to identify patient and environmental factors associated with delayed presentations to the ED after onset of stroke symptoms.
AHRQ-funded; HS022400.
Citation: Trent SA, Morse EA, Ginde AA .
Barriers to prompt presentation to emergency departments in Colorado after onset of stroke symptoms.
West J Emerg Med 2019 Mar;20(2):237-43. doi: 10.5811/westjem.2018.10.38731..
Keywords: Emergency Department, Stroke, Cardiovascular Conditions, Healthcare Delivery
O'Brien EC, Holmes DN, Thomas L
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
This study investigated whether renal function predicted stroke in patients diagnosed with atrial fibrillation (AF). Data from the Outcomes Registry for Better Informed Treatment (ORBIT-AF) was used. Investigators concluded that renal dysfunction was not independently associated with embolic risk in either treated or untreated patients.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Holmes DN, Thomas L .
Incremental prognostic value of renal function for stroke prediction in atrial fibrillation.
Int J Cardiol 2019 Jan 1;274:152-57. doi: 10.1016/j.ijcard.2018.07.113..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Risk, Stroke
Garg R, Prabhakaran S, Holl JL
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
Gastrostomy placement after intracerebral hemorrhage indicates the need for continued medical care and predicts patient dependence. The objective of this study was to determine the optimal machine learning technique to predict gastrostomy. The investigators concluded that machine learning techniques other than logistic regression (eg, random forests, extreme gradient boost, and kth nearest neighbors) were significantly more accurate for predicting gastrostomy using the same independent variables.
AHRQ-funded; HS023437.
Citation: Garg R, Prabhakaran S, Holl JL .
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
J Stroke Cerebrovasc Dis 2018 Dec;27(12):3570-74. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.026..
Keywords: Stroke
Borre ED, Goode A, Raitz G
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
This systematic review compared the strength of tools to predict stroke and bleeding risk in patients with atrial fibrillation (AF) taking blood thinners. Sixty-one studies were found to predict thromboembolic risk and 38 to predict bleeding risk.
AHRQ-funded; 290201500004I.
Citation: Borre ED, Goode A, Raitz G .
Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
Thromb Haemost 2018 Dec;118(12):2171-87. doi: 10.1055/s-0038-1675400..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Blood Clots, Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Patient-Centered Outcomes Research, Evidence-Based Practice
Williams CN, Piantino J, McEvoy C
The burden of pediatric neurocritical care in the United States.
This article attempts to quantify the burden of pediatric neurocritical care (PNCC) by developing national estimates of disease incidence, evaluating use of critical care interventions (CCI), and examining hospital outcomes. The Kids Inpatient Database (KID) was analyzed to evaluate cohorts with the following conditions: traumatic brain injury, neuro-infection, or inflammatory diseases; status epilepticus; stroke; hypoxic ischemic injury after cardiac arrest; or spinal cord injury.
AHRQ-funded; HS022981.
Citation: Williams CN, Piantino J, McEvoy C .
The burden of pediatric neurocritical care in the United States.
Pediatr Neurol 2018 Dec;89:31-38. doi: 10.1016/j.pediatrneurol.2018.07.013..
Keywords: Children/Adolescents, Critical Care, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Neurological Disorders, Stroke, Trauma
Desai RJ, Wyss R, Jin Y
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Use of disease risk score (DRS)-based confounding adjustment when estimating treatment effects on multiple outcomes is not well studied. In this empirical cohort study, the investigators compared dabigatran initiators and warfarin initiators with respect to risks of ischemic stroke and major bleeding in 12 sequential monitoring periods (90 days each), using data from the Truven Marketscan database (Truven Health Analytics, Ann Arbor, Michigan).
AHRQ-funded; HS022193.
Citation: Desai RJ, Wyss R, Jin Y .
Extension of disease risk score-based confounding adjustments for multiple outcomes of interest: an empirical evaluation.
Am J Epidemiol 2018 Nov;187(11):2439-48. doi: 10.1093/aje/kwy130.
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Keywords: Blood Thinners, Cardiovascular Conditions, Medication, Outcomes, Research Methodologies, Risk, Stroke
Smith TM, Pappadis MR, Krishnan S
Stroke survivor and caregiver perspectives on post-stroke visual concerns and long-term consequences.
The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities.
AHRQ-funded; HS022134; HS024711.
Citation: Smith TM, Pappadis MR, Krishnan S .
Stroke survivor and caregiver perspectives on post-stroke visual concerns and long-term consequences.
Behav Neurol 2018 Oct 4;2018:1463429. doi: 10.1155/2018/1463429..
Keywords: Caregiving, Stroke
Hirayama A, Goto T, Faridi MK
Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.
The purpose of this study was to examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Results showed that, among 620,788 hospitalizations, advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.
Int J Stroke 2018 Oct;13(7):717-24. doi: 10.1177/1747493018772790..
Keywords: Elderly, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Hospitalization, Stroke
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
Hong I, Karmarker A, Chan W
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Investigators explored variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke. They found demographic and clinical differences among stroke patients admitted for post-acute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Additionally, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
AHRQ-funded; HS022134; HS024711.
Citation: Hong I, Karmarker A, Chan W .
Discharge patterns for ischemic and hemorrhagic stroke patients going from acute care hospitals to inpatient and skilled nursing rehabilitation.
Am J Phys Med Rehabil 2018 Sep;97(9):636-45. doi: 10.1097/phm.0000000000000932..
Keywords: Transitions of Care, Hospital Discharge, Stroke, Cardiovascular Conditions, Nursing Homes, Rehabilitation
Moreno A, Schwamm LH, Siddiqui KA
Frequent hub-spoke contact is associated with improved spoke hospital performance: results from the Massachusetts General Hospital Telestroke Network.
This study investigated the association of a strong hub-spoke hospital connection with improved spoke hospital performance for acute ischemic stroke patients associated with the Massachusetts General Hospital Telestroke Network. Investigators identified 375 patients treated with tPA by conventional or telestroke methods from 2006-2015 with 16 spoke hospitals. There was a positive association between more frequent contact between a telestroke spoke and its hub and faster tPA delivery for patients.
AHRQ-funded; HS024561.
Citation: Moreno A, Schwamm LH, Siddiqui KA .
Frequent hub-spoke contact is associated with improved spoke hospital performance: results from the Massachusetts General Hospital Telestroke Network.
Telemed J E Health 2018 Sep;24(9):678-83. doi: 10.1089/tmj.2017.0252..
Keywords: Health Information Technology (HIT), Hospitals, Provider Performance, Quality of Care, Stroke, Telehealth
Lakshminarayan K, Westberg S, Northuis C
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Hypertension (HTN) is significantly under-treated in stroke survivors. The study authors examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control. They concluded that a mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.
AHRQ-funded; HS021794.
Citation: Lakshminarayan K, Westberg S, Northuis C .
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Contemp Clin Trials 2018 Jul;70:24-34. doi: 10.1016/j.cct.2018.05.005..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Stroke, Cardiovascular Conditions
Regenhardt RW, Mecca AP, Flavin SA
Delays in the air or ground transfer of patients for endovascular thrombectomy.
This study’s objective was to examine associations between transfer time, modes of transfer, endovascular therapy (ET), and outcomes within a hub-and-spoke telestroke network. Results showed an association between longer transfer time and decreased likelihood of undergoing ET. Nocturnal transfers were associated with a substantial delay relative to daytime transfers. In contrast, delivery of tPA was not associated with delays, underscoring the impact of effective protocols at spoke hospitals. More efficient transfer may enable higher ET treatment rates.
AHRQ-funded; HS024561.
Citation: Regenhardt RW, Mecca AP, Flavin SA .
Delays in the air or ground transfer of patients for endovascular thrombectomy.
Stroke 2018 Jun;49(6):1419-25. doi: 10.1161/strokeaha.118.020618.
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Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Telehealth, Transitions of Care, Stroke
Krishnan S, Pappadis MR, Weller SC
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
This study explored the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. Frequently mentioned outcome preferences by survivors were ability to walk (88 percent), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53 percent), prevent falls, have home accommodations, and transfer independently.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Pappadis MR, Weller SC .
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
Disabil Rehabil 2018 Jun;40(12):1401-09. doi: 10.1080/09638288.2017.1297855.
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Keywords: Caregiving, Patient-Centered Outcomes Research, Patient Safety, Rehabilitation, 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
Sterling MR, Durant RW, Bryan J
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
Researchers compared the association of N-terminal pro B-type peptide (NT-proBNP) with risk of incident typical myocardial infarction (MI) and microsize MI in the REasons for Geographic and Racial Differences in Stroke Study. Over a median of 5 years of follow-up, there were 315 typical MI, 139 microsize MI, and 195 incident fatal coronary heart disease (CHD). NT-proBNP was independently and strongly associated with all CHD endpoints, with significantly greater risk observed for incident microsize MI.
AHRQ-funded; HS000066.
Citation: Sterling MR, Durant RW, Bryan J .
N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study.
BMC Cardiovasc Disord 2018 Apr 16;18(1):66. doi: 10.1186/s12872-018-0806-4.
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Keywords: Heart Disease and Health, Racial and Ethnic Minorities, Risk, Stroke
Fudim M, Liu PR, Shrader P
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. In order to better understand MRA use and subsequent outcomes, the investigators performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
AHRQ-funded; HS021092.
Citation: Fudim M, Liu PR, Shrader P .
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007987..
Keywords: Cardiovascular Conditions, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention, Registries, Stroke