Clinical Efficiency Tools Improve Stroke Management in a Rural Southern Health System

140

102

Background and Purpose— The purpose of this study was to evaluate the impact of new treatments by examining the changes between 1990 to 1991 and 2000 to 2001 in in-hospital mortality rates and hospital charges in adult patients with stroke. Methods— From the Nationwide Inpatient Survey, the largest all-payer inpatient care database in the United States, patients with stroke admitted in 1990 to 1991 or 2000 to 2001 were studied. We analyzed hospital charges (adjusted for inflation based on the Consumer Price Index of the Bureau of Labor Statistics) and patient outcomes by type of institution: rural, urban nonteaching, and urban teaching in 1990 to 1991 and in 2000 to 2001. Results— In 1990 to 1991, there were 1 736 352 admissions for cerebrovascular diseases, and in 2000 to 2001, there were 1 958 018 admissions. The number of admissions in urban teaching hospitals increased by 13%, 19%, and 25%, for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall in-hospital mortality rate relatively declined by 36% for ischemic stroke, by 6% for intracerebral hemorrhages, and by 10% for subarachnoid hemorrhage. The mean hospital charges increased from $10 500 to $16 200 for patients with ischemic stroke, from $18 300 to $28 800 for patients with intracerebral hemorrhage, and from $37 400 to $65 900 for patients with subarachnoid hemorrhage. Mortality rates among patients admitted after ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were all lower in urban teaching hospitals than in rural and urban nonteaching hospitals and the mean charges per admission were all higher. Conclusions— There has been an increase in the inflation-adjusted hospital charges for all patients with stroke and a reduction in mortality rates for all stroke subtypes probably related to an increase in the proportion of patients with stroke admitted to urban teaching hospitals.

Section: Methodsmentioning

confidence: 99%

Changes in Cost and Outcome Among US Patients With Stroke Hospitalized in 1990 to 1991 and Those Hospitalized in 2000 to 2001

Qureshi

Suri

Nasar

et al. 2007

140

102

“…Questionnaire responses were tested for internal validity by comparing responses to similar questions. On the basis of these results and outcomes of previous studies, 2,6,[11][12][13][14][15][16][17] several specific institutional characteristics were chosen as treatment variables for further study. All institutional questionnaire responses demonstrating internal consistency and variability were tested for their effect on outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…2 Other studies have shown that more systematic stroke care improves efficiency, but few have evaluated mortality or functional outcomes. [3][4][5][6] The BAC recognized the importance of outcome-based research to establish the efficacy of stroke centers. 1 In an attempt to evaluate the elements of stroke centers recommended by the BAC, we examined their effects on ischemic stroke outcomes in a cohort of patients admitted to academic medical centers throughout the United States.…”

mentioning

confidence: 99%

Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum

2001

Background and Purpose-Data supporting the efficacy of stroke center characteristics are limited. Methods-A questionnaire detailing stroke treatment practices was sent to 42 academic medical centers in the University Health Systems Consortium. In-hospital mortality of all emergency department admissions for ischemic stroke at these institutions was evaluated in a database of discharge abstracts during 1997-1999. Institutional characteristics were evaluated as predictors of in-hospital mortality after adjustment for age, sex, race, hospital treatment volume of ischemic stroke, and admission status (emergent, urgent, elective). Length of stay (LOS), total hospital charges, and frequency of tissue plasminogen activator (tPA) administration were evaluated as secondary outcomes. We used a multivariable method called generalized estimating equations, which broadens confidence intervals to adjust for clustering of variables at institutions. Results-Thirty-two institutions completed the questionnaire, and 29 of these were included in the database of discharge abstracts. In-hospital deaths occurred in 758 (7.0%) of the 10 880 ischemic stroke patients admitted through the emergency department. In-hospital deaths were less frequent at hospitals with a vascular neurologist (odds ratio

“…36 -38 Such protocols can be implemented across a multihospital system to reflect individual diagnostic capabilities and treatment preferences. 31,39 For a PSC, such protocols should include the emergent care of patients with ischemic and hemorrhagic strokes, including stabilization of vital functions, initial diagnostic tests, and the use of various medications. These protocols could be based on previously published ones or could be developed by a multidisciplinary team organized by the Stroke Center.…”

Section: Written Care Protocolsmentioning

confidence: 99%

Revised and Updated Recommendations for the Establishment of Primary Stroke Centers

Alberts

Latchaw

Jagoda

et al. 2011

195

167

for the Brain Attack CoalitionBackground and Purpose-The formation and certification of Primary Stroke Centers has progressed rapidly since the Brain Attack Coalition's original recommendations in 2000. The purpose of this article is to revise and update our recommendations for Primary Stroke Centers to reflect the latest data and experience. Methods-We conducted a literature review using MEDLINE and PubMed from March 2000 to January 2011. The review focused on studies that were relevant for acute stroke diagnosis, treatment, and care. Original references as well as meta-analyses and other care guidelines were also reviewed and included if found to be valid and relevant. Levels of evidence were added to reflect current guideline development practices. Results-Based on the literature review and experience at Primary Stroke Centers, the importance of some elements has been further strengthened, and several new areas have been added. These include (1) the importance of acute stroke teams; (2) the importance of Stroke Units with telemetry monitoring; (3) performance of brain imaging with MRI and diffusion-weighted sequences; (4) assessment of cerebral vasculature with MR angiography or CT angiography; (5) cardiac imaging; (6) early initiation of rehabilitation therapies; and (7) certification by an independent body, including a site visit and disease performance measures. Conclusions-Based on the evidence, several elements of Primary Stroke Centers are particularly important for improving the care of patients with an acute stroke. Additional elements focus on imaging of the brain, the cerebral vasculature, and the heart. These new elements may improve the care and outcomes for patients with stroke cared for at a Primary Stroke Center. (Stroke. 2011;42:2651-2665.)