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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 147 Research Studies Displayed
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)
Meng T, Trickey AM, Harris AHS
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
The authors’ objectives were to assess and validate the change in intravenous thrombolysis (IVT) utilization in a national sample of Medicare beneficiaries and to examine the effect of patient, stroke center designation, and geography on IVT utilization. They found that, between 2007 and 2014, the frequency of IVT for patients with acute ischemic stroke increased substantially, though differences persisted in the form of less frequent treatment associated with certain characteristics.
AHRQ-funded; HS026207.
Citation:
Meng T, Trickey AM, Harris AHS .
Lessons learned from the historical trends on thrombolysis use for acute ischemic stroke among Medicare beneficiaries in the United States.
Front Neurol 2022 Mar 4;13:827965. doi: 10.3389/fneur.2022.827965..
Keywords:
Stroke, Cardiovascular Conditions, Blood Thinners
Yan Z, Nielsen V, Song G
Integration of regional hospitalizations, registry and vital statistics data for development of a single statewide ischemic stroke database.
The scope of population-based studies is often limited because databases rarely include detailed clinical variables and vital statistics such as death rates. The study team demonstrated a comprehensive process for integrating three clinical variable, vital statistics, and hospitalization databases into one single, statewide, ischemic stroke database. Using databases spanning 2007-2017, the authors identified and validated linkages between stroke admissions in a hospitalization database (47,713 admissions) and admissions in the stroke registry (43,487 admissions), resulting in 38,493 linked cases (80.7% of total cases) of which 95% were validated. Of the 38,493 linked cases, the authors linked 10,660 to deaths from the vital statistics database, resulting in a comprehensive assessment of cumulative mortality from ischemic strokes over a 7-year period among all registry-linked ischemic stroke hospitalization records. The authors concluded that comprehensive, accurate integration of the clinical registry, statewide hospitalizations, and vital statistics databases is achievable, and may have value for outcomes research on a larger scale.
AHRQ-funded; HS024561.
Citation:
Yan Z, Nielsen V, Song G .
Integration of regional hospitalizations, registry and vital statistics data for development of a single statewide ischemic stroke database.
J Stroke Cerebrovasc Dis 2022 Mar;31(3):106236. doi: 10.1016/j.jstrokecerebrovasdis.2021.106236..
Keywords:
Stroke, Cardiovascular Conditions, Registries
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
KS Cash, RE Adeoye, O
Estimated population access to acute stroke and telestroke centers in the US, 2019.
In order to provide an update on population-level access to stroke care, the investigators estimated the proportion of the US population with access to an ED with acute stroke capabilities and assessed the specific contribution of telestroke services to US population access. They observed a substantial increase in population access to acute stroke care in this cross-sectional study relative to previous reports using alternative methods, likely due to the extensive and ongoing work to improve stroke systems of care, including greater stroke center accreditation and expansion of telestroke capacity.
AHRQ-funded; HS024561.
Citation:
KS Cash, RE Adeoye, O .
Estimated population access to acute stroke and telestroke centers in the US, 2019.
JAMA Netw Open 2022 Feb;5(2):e2145824. doi: 10.1001/jamanetworkopen.2021.45824..
Keywords:
Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Critical Care, Access to Care
Mallela DP, Canner JK, Zarkowsky DS
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
This study investigated the association of race on carotid endarterectomy (CEA) outcomes. Perioperative outcomes (at 30 days) were compared for Black vs. White patients adjusting for age/sex, comorbidities and disease characteristics. Out of 16,764 patients from the ACS-NSQIP targeted vascular database (2011-2019), 95.2% were White and 4.8% were Black. Black patients were slightly younger and more frequently (79.5% vs 74.0%) had high-grade carotid artery stenosis compared to White patients. Comorbidities including hypertension, diabetes, kidney disease, congestive heart failure, and coronary artery disease were all more prevalent among Black patients. Crude perioperative stroke and stroke/death were higher for Black patients, but myocardial infarction leading to death were similar. After adjusting for baseline differences between groups, the risk of perioperative stroke and stroke/death remained significantly higher for Black patients than White patients.
AHRQ-funded; HS024547.
Citation:
Mallela DP, Canner JK, Zarkowsky DS .
Association between race and perioperative outcomes after carotid endarterectomy for asymptomatic carotid artery stenosis in NSQIP.
J Am Coll Surg 2022 Jan;234(1):65-73. doi: 10.1097/xcs.0000000000000016..
Keywords:
Racial / Ethnic Minorities, Surgery, Cardiovascular Conditions, Stroke, Risk, Adverse Events
Boehme AK, Oka M, Cohen B
Readmission rates in stroke patients with and without infections: incidence and risk factors.
Investigators examined whether an infection acquired during the initial stroke admission contributed to increased risk of readmission and infection during readmission. Their a retrospective cohort study incorporated all adult ischemic stroke patients 2006-2016 from three New York City hospitals. They found that, among stroke patients, healthcare-associated infections and infections present on admission were predictors of readmission within 60 days and infection during readmission.
AHRQ-funded; HS024915.
Citation:
Boehme AK, Oka M, Cohen B .
Readmission rates in stroke patients with and without infections: incidence and risk factors.
J Stroke Cerebrovasc Dis 2022 Jan;31(1):106172. doi: 10.1016/j.jstrokecerebrovasdis.2021.106172..
Keywords:
Stroke, Cardiovascular Conditions, Hospital Readmissions, Risk, Healthcare-Associated Infections (HAIs)
Zachrison KS, Schwamm LH, Xu H
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. In this study, the investigators assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines-Stroke clinical registry.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Schwamm LH, Xu H .
Frequency, characteristics, and outcomes of endovascular thrombectomy in patients with stroke beyond 6 hours of onset in US clinical practice.
Stroke 2021 Dec;52(12):3805-14. doi: 10.1161/strokeaha.121.034069..
Keywords:
Stroke, Cardiovascular Conditions, Surgery, Outcomes
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)
Prabhakaran S, Khorzad R, Parnianpour Z
Door-in-door-out process times at primary stroke centers in Chicago.
This study sought to identify modifiable predictors of door-in-door-out times for transfer of acute stroke patients from primary stroke centers to comprehensive stroke centers using 3 Chicago-region primary stroke centers as a model. A retrospective analysis of consecutive patients with acute stroke from February 2018 to January 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers was conducted. Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2% of patients, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) at the primary stroke center. The median door-in-door-out time was 148.5 minutes. The largest contributors to longer door-in-door-out times were CT to CT angiography time, transfer center contact to ambulance request time, ambulance request to arrive time, and transfer ambulance at primary stroke center. Other factors included CT angiography performed at the primary stroke center, walk-in arrival mode, administration of intravenous alteplase request by primary stroke center, and ambulance request by the primary stroke center.
AHRQ-funded; HS025359.
Citation:
Prabhakaran S, Khorzad R, Parnianpour Z .
Door-in-door-out process times at primary stroke centers in Chicago.
Ann Emerg Med 2021 Nov;78(5):674-81. doi: 10.1016/j.annemergmed.2021.06.018..
Keywords:
Stroke, Cardiovascular Conditions, Healthcare Delivery, Emergency Department
Zachrison KS, Sharma R, Wang Y
National trends in telestroke utilization in a US commercial platform prior to the COVID-19 pandemic.
In this study, the objective was to describe characteristics of telestroke consultations among a national sample of telestroke sites on one of the most commonly used common vendor platforms, prior to the COVID-19 public health emergency. The investigators concluded that among spoke sites using a commercial telestroke platform over a seven-year time horizon, times to consult start and alteplase bolus decreased over time. Similar to academic networks, duration of telestroke participation in this commercial network was associated with faster alteplase delivery, suggesting practice improves performance.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Sharma R, Wang Y .
National trends in telestroke utilization in a US commercial platform prior to the COVID-19 pandemic.
J Stroke Cerebrovasc Dis 2021 Oct;30(10):106035. doi: 10.1016/j.jstrokecerebrovasdis.2021.106035..
Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Practice Patterns
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)
Papaleontiou M, Levine DA, Reyes-Gastelum D
Thyroid hormone therapy and incident stroke.
This study’s objective was to determine the relationship between thyroid hormone treatment intensity and incidence of atrial fibrillation (AFIB) and stroke. This retrospective cohort study used data from the Veterans Health Administration between 2004 and 2017, with a median follow-up of 59 months. Total study population was comprised of 733,208 thyroid hormone users aged ≥18 years with at least 2 thyroid stimulating hormone (TSH) measurements between thyroid hormone initiation and incident event (atrial fibrillation or stroke) or study conclusion. Overall, 71,333 (11.08%) developed incident atrial fibrillation and 41,931 (6.32%) stroke. Higher incidence of stroke was associated with low thyroid-stimulation hormone (TSH) or high free thyroxine (T4) levels compared to patients with normal TSH or T4 levels. Risk of developing AFIB and stroke was cumulative over time for patients with exogenous hyperthyroidism or hypothyroidism.
AHRQ-funded; HS024512.
Citation:
Papaleontiou M, Levine DA, Reyes-Gastelum D .
Thyroid hormone therapy and incident stroke.
J Clin Endocrinol Metab 2021 Sep 27;106(10):e3890-e900. doi: 10.1210/clinem/dgab444..
Keywords:
Medication, Medication: Safety, Risk, Stroke
Vaghani V, Wei L, U
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
Diagnostic errors are major contributors to preventable patient harm. In this study, the investigators validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs). The investigators concluded that a symptom-disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.
AHRQ-funded; HS017820; HS024459.
Citation:
Vaghani V, Wei L, U .
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
J Am Med Inform Assoc 2021 Sep 18;28(10):2202-11. doi: 10.1093/jamia/ocab121..
Keywords:
Stroke, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Adverse Events
Hou Y, Bushnell CD, Duncan PW
Hospital to home transition for patients with stroke under bundled payments.
In this paper, the authors describe COMprehensive Post-Acute Stroke Services (COMPASS), a comprehensive transitional care intervention focused on discharge from the acute care setting to home. The COMPASS care model is aligned with the incentive structures and essential components of bundled payments in terms of care coordination, patient assessment, patient and family involvement, and continuity of care. They concluded that ongoing evaluation will inform the design of incorporating COMPASS-like transitional care interventions into a stroke bundle.
AHRQ-funded; R01 HS025723.
Citation:
Hou Y, Bushnell CD, Duncan PW .
Hospital to home transition for patients with stroke under bundled payments.
Arch Phys Med Rehabil 2021 Aug;102(8):1658-64. doi: 10.1016/j.apmr.2021.03.010..
Keywords:
Transitions of Care, Stroke, Cardiovascular Conditions, Rehabilitation, Care Coordination
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)
Sico JJ, Kundu S, So-Armah K
Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study.
Background HIV infection and depression are each associated with increased ischemic stroke risk. Whether depression is a risk factor for stroke within the HIV population is unknown. In this study the investigators examined depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study. The investigators concluded that depression is associated with an increased risk of stroke among HIV-positive people after adjusting for sociodemographic characteristics, traditional cerebrovascular risk factors, and HIV-specific factors.
AHRQ-funded; HS023464.
Citation:
Sico JJ, Kundu S, So-Armah K .
Depression as a risk factor for incident ischemic stroke among HIV-positive veterans in the veterans aging cohort study.
J Am Heart Assoc 2021 Jul 6;10(13):e017637. doi: 10.1161/jaha.119.017637..
Keywords:
Depression, Behavioral Health, Risk, Veterans, Human Immunodeficiency Virus (HIV), Stroke, Cardiovascular Conditions
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation:
Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords:
Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Zachrison KS, Li S, Reeves MJ
Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases.
Administrative data are frequently used in stroke research. Ensuring accurate identification of patients who had an ischaemic stroke, and those receiving thrombolysis and endovascular thrombectomy (EVT) is critical to ensure representativeness and generalisability. In this study, the investigators examined differences in patient samples based on mode of identification, and proposed a strategy for future patient and procedure identification in large administrative databases.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Li S, Reeves MJ .
Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases.
Stroke Vasc Neurol 2021 Jun;6(2):194-200. doi: 10.1136/svn-2020-000533..
Keywords:
Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality
Etherton MR, Zachrison KS, Yan Z
Regional changes in patterns of stroke presentation during the COVID-19 pandemic.
The authors sought to determine the effect of the coronavirus pandemic on patterns of stroke patient presentation and quality of care. They analyzed data from 25 New England hospitals: one urban, academic, comprehensive stroke center and telestroke hub, and 24 spoke hospitals in the same telestroke network. They included all telestroke consultations from the 24 spokes, and stroke admissions to the comprehensive stroke center hub from November 2019 through April 2020. They compared rates of presentation, timeliness presentation, and quality of care pre- versus post-March 2020. They also examined trends in patient demographics, stroke severity, timeliness, diagnosis including large vessel occlusion, alteplase use, and endovascular thrombectomy among eligible subjects. Among 1248 patient presentations, telestroke consultations and ischemic stroke patient admissions decreased through the hub and spoke network. Age and stroke severity were unchanged during the study period. However, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic.
AHRQ-funded; HS024561.
Citation:
Etherton MR, Zachrison KS, Yan Z .
Regional changes in patterns of stroke presentation during the COVID-19 pandemic.
Stroke 2021 Apr;52(4):1398-406. doi: 10.1161/strokeaha.120.031300..
Keywords:
Stroke, Cardiovascular Conditions, COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation:
Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords:
Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Zachrison KS, Natsui S, Luan Erfe BM
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
The objective of this study was to determine whether acute ischemic stroke (AIS) patients' language preference was associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. The investigators concluded that consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Natsui S, Luan Erfe BM .
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
Am J Emerg Med 2021 Feb;40:177-80. doi: 10.1016/j.ajem.2020.10.064..
Keywords:
Stroke, Cardiovascular Conditions, Emergency Department, Cultural Competence, Diagnostic Safety and Quality
Bayliss WS, Bushnell CD, Halladay JR
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
This study compares the outcomes of using the COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged to home against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. Hospital-level costs associated with implementing and sustaining COMPASS were examined during a 1-year period. Out of 40 hospitals, 22 hospitals were actively engaged in COMPASS. A 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient. About half of hospitals (N = 10) reported postacute clinic visits as their highest cost activity, while 7 hospitals reported case ascertainment as their highest cost activity. The authors estimated that based on average costs of COMPASS and readmissions, COMPASS could lower net costs if the model can prevent about 6 readmissions per year.
AHRQ-funded; HS025723.
Citation:
Bayliss WS, Bushnell CD, Halladay JR .
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
Med Care 2021 Feb;59(2):163-68. doi: 10.1097/mlr.0000000000001462..
Keywords:
Stroke, Cardiovascular Conditions, Healthcare Costs, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Su CM, Warren A, Kraus C
Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage.
Int J Emerg Med 2021 Jan 19;14(1):6. doi: 10.1186/s12245-021-00329-w.
Early diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. In this study the investigators examined whether racial or ethnic disparities existed in acute care processes in the first hours after ICH. The investigators found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
Early diagnosis and treatment of intracerebral hemorrhage (ICH) is thought to be critical for improving outcomes. In this study the investigators examined whether racial or ethnic disparities existed in acute care processes in the first hours after ICH. The investigators found no evidence of racial/ethnic disparities in acute care processes or outcomes in ICH. English as first language, however, was associated with slower care processes.
AHRQ-funded; HS024561.
Citation:
Su CM, Warren A, Kraus C .
Lack of racial and ethnic-based differences in acute care delivery in intracerebral hemorrhage.
Int J Emerg Med 2021 Jan 19;14(1):6. doi: 10.1186/s12245-021-00329-w..
Keywords:
Racial / Ethnic Minorities, Disparities, Critical Care, Stroke, Cardiovascular Conditions, Outcomes
Khodneva Y, Richman J, Kertesz S
Gender differences in association of prescription opioid use and mortality: a propensity-matched analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) prospective cohort.
Prescription opioids (PO) have been widely used for chronic non-cancer pain, with commensurate concerns for overdose. The long-term effect of these medications on non-overdose mortality in the general population remains poorly understood. This study's objective was to examine the association of prescription opioid use and mortality in a large cohort, accounting for gender differences and concurrent benzodiazepine use, and using propensity score matching.
AHRQ-funded; HS013852.
Citation:
Khodneva Y, Richman J, Kertesz S .
Gender differences in association of prescription opioid use and mortality: a propensity-matched analysis from the REasons for Geographic And Racial Differences in Stroke (REGARDS) prospective cohort.
Subst Abus 2021;42(1):94-103. doi: 10.1080/08897077.2019.1702609..
Keywords:
Stroke, Cardiovascular Conditions, Sex Factors, Opioids, Medication, Mortality
