National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Blood Thinners (3)
- Cardiovascular Conditions (12)
- Caregiving (1)
- Diagnostic Safety and Quality (2)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Elderly (2)
- Emergency Medical Services (EMS) (1)
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- Outcomes (3)
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- Provider: Clinician (1)
- (-) Stroke (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)
Zachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Reistetter T, Hreha K, Dean JM
The pre-adaptation of a stroke-specific self-management program among older adults.
To understand the management of multimorbidity in aging stroke survivors and to examine the complex relationships between comorbidities, researchers used visual analytics to identify patient subgroup. Five significant subgroups of comorbidities such as obesity and cancer were identified. An interdisciplinary team constructed six vignettes that highlighted multimorbidity to customize a self-management program that fitted the needs of older adult stroke survivors.
AHRQ-funded; HS026133.
Citation: Reistetter T, Hreha K, Dean JM .
The pre-adaptation of a stroke-specific self-management program among older adults.
J Aging Health 2023 Oct; 35(9):632-42. doi: 10.1177/08982643231152520..
Keywords: Stroke, Cardiovascular Conditions, Elderly, Patient Self-Management
Troy AL, Herzig SJ, Trivedi S
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
This study investigated prevalence of oral anticoagulant initiation for newly diagnosed US older adults with atrial fibrillation within 7 days of hospital discharge. The authors used a 20% national sample of Medicare fee-for-service beneficiaries, identifying patients aged 65 years or older newly diagnosed with atrial fibrillation while hospitalized in 2016. Among 38,379 older adults newly diagnosed with atrial fibrillation while hospitalized (mean age 78.2; 51.8% female; 83.3% white), 36,633 (95.4%) had an indication for anticoagulation and 24.6% (9011) of those initiated an oral anticoagulant following discharge. Higher CHA(2) DS(2) -VASc score was associated with a small increase in oral anticoagulant initiation (predicted probability 20.5% for scores <2 and 24.9% for ≥4). Elevated HAS-BLED score was associated with a small decrease in probability of anticoagulant initiation (25.4% for score <2 and 23.1% for ≥3). Frailty was associated with decreased likelihood of oral anticoagulant initiation (24.7% for non-frail and 18.1% for moderately-severely frail). Anticoagulant initiation varied by primary reason for hospitalization, with predicted probability highest among patients with a primary diagnosis of atrial fibrillation (46.1%) and lowest among those with non-cardiovascular conditions (13.8%) and bleeds (3.6%).
AHRQ-funded; HS026215.
Citation: Troy AL, Herzig SJ, Trivedi S .
Initiation of oral anticoagulation in US older adults newly diagnosed with atrial fibrillation during hospitalization.
J Am Geriatr Soc 2023 Sep; 71(9):2748-58. doi: 10.1111/jgs.18375..
Keywords: Elderly, Blood Thinners, Medication, Heart Disease and Health, Cardiovascular Conditions, Stroke
Tarnutzer AA, Gold D, Wang Z
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Researchers conducted a systematic review to assess the accuracy of bedside diagnosis of acute dizziness/vertigo to differentiate peripheral vestibular from central neurologic causes. Their review indicated that the Head Impulse, Nystagmus, Test of Skew (HINTS) examination by trained clinicians can differentiate peripheral from central causes and show higher diagnostic accuracy for stroke in the first 24-48 hours than MRI diffusion-weighted imaging. They concluded that these techniques should be disseminated to clinicians evaluating dizziness/vertigo.
AHRQ-funded; HS029350.
Citation: Tarnutzer AA, Gold D, Wang Z .
Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the acute vestibular syndrome - a meta-analysis.
Ann Neurol 2023 Aug; 94(2):295-308. doi: 10.1002/ana.26661..
Keywords: Diagnostic Safety and Quality, Training, Education: Continuing Medical Education, Provider: Clinician, Stroke, Cardiovascular Conditions
Patel PB, Marcaccio CL, Swerdlow NJ
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
This study’s objective was to examine the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair (EVAR). The authors identified all patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022. Patients were then stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. Primary outcomes across the different treatment groups was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE). They identified a total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs, with TALE observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR, TEVAR, and extent I to III TAAA repair. Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and arch repair. The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE. Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR, complex EVAR, TEVAR, and extent I to III TAAA repair.
AHRQ-funded; HS027285.
Citation: Patel PB, Marcaccio CL, Swerdlow NJ .
Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative.
J Vasc Surg 2023 Aug; 78(2):269-77.e3. doi: 10.1016/j.jvs.2023.03.499..
Keywords: Surgery, Stroke, Cardiovascular Conditions
Derington CG, Goodrich GK, Xu S
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
This study investigated the impact of an anticoagulation management service (AMS) on clinical outcomes of adults with atrial fibrillation (AF). This retrospective cohort study was conducted in 3 Kaiser Permanente regions, with each region taking a slightly different approach to direct oral anticoagulant (DOAC) care. These approaches included (1) usual care (UC) by the prescribing clinician, (2) UC plus an automated population management tool (PMT), or (3) pharmacist-managed AMS care. The study included 44,746 adults with a diagnosis of AF who initiated DOAC or warfarin between August 2016 and January 1, 2020, 6182 in the UC model, 33,624 in the UC plus PMT care model, and 4939 in the AMS care model. Baseline characteristics (mean age, 73.1 years, 56.1% male, 67.2% non-Hispanic White, median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, female sex] score of 3 [IQR, 2-5]) were well balanced after inverse probability of treatment weighting (IPTW). The cohort was followed over a median of 2 years, and patients who received the UC plus PMT or AMS care model did not have significantly better outcomes than those who received only UC.
AHRQ-funded; HS026156.
Citation: Derington CG, Goodrich GK, Xu S .
Association of direct oral anticoagulation management strategies with clinical outcomes for adults with atrial fibrillation.
JAMA Netw Open 2023 Jul; 6(7):e2321971. doi: 10.1001/jamanetworkopen.2023.21971..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Outcomes, Stroke
Wang SX, Marcaccio CL, Patel PB
Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes.
Researchers sought to assess in-hospital outcomes in patients who had undergone transfemoral carotid artery stenting (tfCAS) with and without embolic protection using a distal filter. Patients undergoing tfCAS were identified in the Vascular Quality Initiative and those who received proximal embolic balloon protection were excluded. Outcomes of interest were stroke, death, composite stroke/death, myocardial infarction, transient ischemic attack, and hyperperfusion syndrome. Results indicated that tfCAS performed without attempted distal embolic protection was associated with higher risk of in-hospital stroke and death; tfCAS after a failed attempt at filter placement had equivalent stroke/death to patients with no filter attempted, but higher risk of stroke/death compared with those with successfully placed filters. The researchers concluded that these findings support current Society for Vascular Surgery guidelines and, if a filter cannot be safely placed, alternative approaches to carotid revascularization should be considered.
AHRQ-funded; HS027285.
Citation: Wang SX, Marcaccio CL, Patel PB .
Distal embolic protection use during transfemoral carotid artery stenting is associated with improved in-hospital outcomes.
J Vasc Surg 2023 Jun; 77(6):1710-19.e6. doi: 10.1016/j.jvs.2023.01.210..
Keywords: Cardiovascular Conditions, Outcomes, Stroke
Marcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Liberman AL, Holl JL, Romo E
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
The authors conducted a failure modes, effects, and criticality analysis (FMECA) of the emergency department (ED)-based acute stroke diagnostic process at three health systems in Chicago. The FMECA was designed to identify and rank order failures in the processes of care. The authors found that failure to use existing screening scales to identify patients with large-vessel occlusions early in the ED course ranked highest; other highly ranked failures were obtaining an accurate history of the index event, suspecting acute stroke in triage, and using established stroke screening tools at ED arrival to identify potential stroke patients. They concluded that these results highlight the crucial importance of the first steps in the diagnostic process.
AHRQ-funded; HS025359; HS027264.
Citation: Liberman AL, Holl JL, Romo E .
Risk assessment of the acute stroke diagnostic process using failure modes, effects, and criticality analysis.
Acad Emerg Med 2023 Mar; 30(3):187-95. doi: 10.1111/acem.14648..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality
De Roo AC, Ha J, Regenbogen SE
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
The purpose of this study was to assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at 65. Researchers used Health and Retirement Study survey data covering a 20-year period to compare informal care received by patients who had been hospitalized for stroke, heart surgery, or joint surgery, and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts. Their results showed that onset of Medicare eligibility was associated with a substantial decrease in family and friend caregiving use received by stroke patients, but not in the other acute care cohorts. They concluded that this effect of Medicare coverage on informal caregiving had implications for patient function and caregiver burden, and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity.
AHRQ-funded; HS000053.
Citation: De Roo AC, Ha J, Regenbogen SE .
Impact of Medicare eligibility on informal caregiving for surgery and stroke.
Health Serv Res 2023 Feb; 58(1):128-39. doi: 10.1111/1475-6773.14019..
Keywords: Medicare, Caregiving, Surgery, Stroke, Cardiovascular Conditions
Anjorin AC, Marcaccio CL, Rastogi V
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
This study evaluated the outcomes of carotid artery stenosis (CAS) patients using statin therapy before undergoing carotid revascularization in the Vascular Quality Initiative registry. The authors identified all patients who underwent carotid endarterectomy (CEA), transfemoral carotid artery stenting (tfCAS), or transcarotid artery revascularization (TCAR) in the Vascular Quality Initiative registry from January 2016 to September 2021. Compared with statin use, no statin use was associated with a higher risk of in-hospital stroke or death and 5-year mortality among CEA and tfCAS patients, although there was no significant difference in outcomes among TCAR patients.
AHRQ-funded; HS027285.
Citation: Anjorin AC, Marcaccio CL, Rastogi V .
Statin therapy is associated with improved perioperative outcomes and long-term mortality following carotid revascularization in the Vascular Quality Initiative.
J Vasc Surg 2023 Jan;77(1):158-69.e8. doi: 10.1016/j.jvs.2022.08.019..
Keywords: Cardiovascular Conditions, Medication, Stroke, Surgery, Outcomes