National Healthcare Quality and Disparities Report
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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 25 of 39 Research Studies DisplayedSumner JA, Khodneva Y, Muntner P
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, the authors examined associations among depressive symptoms and stress, alone and in combination, and incident cardiovascular disease (CVD) and all-cause mortality as a function of socioeconomic status. They found that screening for a combination of elevated depressive symptoms and stress in low-income persons may help identify those at increased risk of incident CVD and mortality.
AHRQ-funded; HS023009.
Citation: Sumner JA, Khodneva Y, Muntner P .
Effects of concurrent depressive symptoms and perceived stress on cardiovascular risk in low- and high-income participants: findings from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study.
J Am Heart Assoc 2016 Oct 10;5(10). doi: 10.1161/jaha.116.003930.
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Keywords: Cardiovascular Conditions, Depression, Social Determinants of Health, Stress, Stroke
Nakagawa K, Ahn HJ, Taira DA
Ethnic comparison of 30-day potentially preventable readmissions after stroke in Hawaii.
The authors sought to compare potentially preventable readmissions (PPR) among a multiethnic population in Hawaii. They concluded that the Chinese ethnicity may have a higher risk of 30-day PPR after stroke compared to whites. Other associated factors include mental illness, Medicaid, and Hawaii county.
AHRQ-funded; HS019990.
Citation: Nakagawa K, Ahn HJ, Taira DA .
Ethnic comparison of 30-day potentially preventable readmissions after stroke in Hawaii.
Stroke 2016 Oct;47(10):2611-7. doi: 10.1161/strokeaha.116.013669.
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Keywords: Stroke, Racial and Ethnic Minorities, Hospital Readmissions, Hospitalization, Risk
Kabra R, Girotra S, Vaughan Sarrazin M
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
The authors hypothesized that the addition of African-American ethnicity to the CHA2DS2-VASc score might improve stroke prediction in patients with atrial fibrillation (AF). They found that, in patients over age 65 with newly diagnosed AF, the addition of ethnicity to CHA2DS2-VASc score significantly improved stroke prediction.
AHRQ-funded; HS023104.
Citation: Kabra R, Girotra S, Vaughan Sarrazin M .
Refining stroke prediction in atrial fibrillation patients by addition of African-American ethnicity to CHA2DS2-VASc score.
J Am Coll Cardiol 2016 Aug 2;68(5):461-70. doi: 10.1016/j.jacc.2016.05.044.
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Keywords: Stroke, Heart Disease and Health, Racial and Ethnic Minorities, Risk, Cardiovascular Conditions
Lima FO, Silva GS, Furie KL
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
The authors aimed to develop a simple field scale to identify large vessel occlusion strokes (LVOS). They found that Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a simple scale that, if successfully validated in the field, may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.
AHRQ-funded; HS011392.
Citation: Lima FO, Silva GS, Furie KL .
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
Stroke 2016 Aug;47(8):1997-2002. doi: 10.1161/strokeaha.116.013301.
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Keywords: Care Management, Elderly, Emergency Department, Stroke
Karp DN, Wolff CS, Wiebe DJ
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
The researchers identified clusters of high stroke mortality and adjacent areas of low stroke mortality for US counties and evaluated for regional differences in county-level risk factors. They found that clusters of high stroke mortality exist beyond the 8-state stroke belt, and variation exists within the stroke belt. They recommended reconsideration of the stroke belt definition and suggested increased attention to local determinants of health underlying small area regional variability to inform targeted healthcare interventions.
AHRQ-funded; HS018362.
Citation: Karp DN, Wolff CS, Wiebe DJ .
Reassessing the stroke belt: using small area spatial statistics to identify clusters of high stroke mortality in the United States.
Stroke 2016 Jul;47(7):1939-42. doi: 10.1161/strokeaha.116.012997.
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Keywords: Mortality, Risk, Stroke, Social Determinants of Health
Du XL, Zhang Y, Hardy D
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
The researchers sought to determine the risk of venous thromboembolism (VTE), stroke, ischemic heart disease, and myelodysplastic syndrome (MDS) in association with the receipt of colony-stimulating factors (CSFs) and/or erythropoiesis-stimulating agents (ESAs) in women with breast cancer. They found that receipts of CSFs and ESAs were significantly associated with an increased risk of VTE in women with breast cancer.
AHRQ-funded; HS018956.
Citation: Du XL, Zhang Y, Hardy D .
Associations between hematopoietic growth factors and risks of venous thromboembolism, stroke, ischemic heart disease and myelodysplastic syndrome: findings from a large population-based cohort of women with breast cancer.
Cancer Causes Control 2016 May;27(5):695-707. doi: 10.1007/s10552-016-0742-5.
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Keywords: Blood Clots, Cancer: Breast Cancer, Cardiovascular Conditions, Risk, 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
Brach C
AHRQ Author: Brach C
Even in an emergency, doctors must make informed consent an informed choice.
When a stroke is suspected, a daughter is pressured to consent to her father's treatment without fully understanding the risks.
AHRQ-authored.
Citation: Brach C .
Even in an emergency, doctors must make informed consent an informed choice.
Health Aff 2016 Apr;35(4):739-43. doi: 10.1377/hlthaff.2015.1407.
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Keywords: Case Study, Decision Making, Emergency Department, Health Literacy, Patient and Family Engagement, Stroke
Fonarow GG, Liang L, Thomas L
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
The researchers evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. They concluded that in a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year.
AHRQ-funded; HS019479; HS016964.
Citation: Fonarow GG, Liang L, Thomas L .
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
Stroke 2016 Mar;47(3):836-42. doi: 10.1161/strokeaha.115.011599.
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Keywords: Medicare, Stroke, Elderly, Home Healthcare, Patient-Centered Outcomes Research
Lyerly MJ, Wu TC, Mullen MT
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
The authors sought to determine the effect of telemedicine on access to acute stroke care for racial and ethnic minorities in the state of Texas. They found that telemedicine increased access to acute stroke care for 1.5 million Texans, and they found no evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
AHRQ-funded; HS013852.
Citation: Lyerly MJ, Wu TC, Mullen MT .
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
J Telemed Telecare 2016 Mar;22(2):114-20. doi: 10.1177/1357633x15589534.
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Keywords: Access to Care, Disparities, Racial and Ethnic Minorities, Stroke, Telehealth
Navarro-Millan I, Yang S, DuVall SL
Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration.
The researchers studied the association of serum lipids, inflammation, and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis. They found that in the study population of predominantly male veterans, higher levels of erythrocyte sedimentation rate and C-reactive protein were associated with increased risk of heart attack and stroke, and higher levels of HDL-C were inversely associated with heart attack and stroke.
AHRQ-funded; HS018517
Citation: Navarro-Millan I, Yang S, DuVall SL .
Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration.
Ann Rheum Dis. 2016 Feb;75(2):341-7. doi: 10.1136/annrheumdis-2013-204987..
Keywords: Stroke, Cardiovascular Conditions, Arthritis
Albright KC, Boehme AK, Tanner RM
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
The authors examined racial differences in risk factors being addressed among stroke survivors and those at risk for stroke. They found that addressed hypertension and hyperlipidemia in stroke-naïve participants were significantly lower in blacks than in whites. They concluded that a better understanding of this information is critical to preventing stroke and other vascular diseases.
AHRQ-funded; HS023009; HS013852.
Citation: Albright KC, Boehme AK, Tanner RM .
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
Ethn Dis 2016 Jan 21;26(1):9-16. doi: 10.18865/ed.26.1.9.
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Keywords: Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Prevention, Stroke
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.
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, 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