Electronic Stroke CarePath

Abstract

Abstract-We describe the development, implementation, and outcomes of the first 2 years of the Electronic Stroke CarePath, an initiative developed for management of ischemic stroke patients in an effort to improve efficiency and quality of care for patients. The CarePath consists of care pathways for ischemic stroke that are integrated within the electronic health record. Patient-reported outcomes are collected using an external software platform. Documentation tools, order sets, and clinical decision support were designed to improve efficiency, optimize process measure adherence, and produce clinical data as a byproduct of care that are available for future analyses. Inpatient mortality and length of stay were compared before and after CarePath implementation in ischemic stroke patients after adjustment for case-mix. Postdischarge functional outcomes of patients with ischemic stroke were compared between the first 3 months of rollout and remainder of the study period. From January 2011 to December 2012, there were 1106 patients with ischemic stroke on the CarePath. There was a decline in inpatient mortality in patients with ischemic stroke, but not in control patients with intracerebral or subarachnoid hemorrhage.Completion rate of patient-reported questionnaires at postdischarge stroke follow-up was 72.9%. There was a trend toward improved functional outcomes at follow-up with CarePath implementation. Implementation of the Electronic Stroke CarePath is feasible and may be associated with a benefit in multiple different outcomes after ischemic stroke. This approach may be an important strategy for optimizing stroke care in the future. Goals and Vision of the ProgramImprovements in efficiency, quality, and coordination of care are essential for healthcare institutions to adapt successfully in an era of decreasing reimbursement. Heart disease and stroke, which are leading causes of morbidity, mortality, and healthcare costs in the United States, are often among the first diseases to be involved in healthcare innovations and policy changes. 1,2 They were among the first to have disease-specific process and outcome measures publically reported by the Center for Medicare and Medicaid services (CMS) and to have society supported quality registries. Regional and national systems of care are more advanced in stroke and myocardial infarction than in most other diseases. Solutions developed to improve delivery of care for patients with heart disease, and stroke can serve as models for the treatment of other conditions.One important strategy to improve the efficiency and quality of healthcare is standardization of care. This is often done by implementing evidence-based protocols that incorporate guidelines into care algorithms. Evidence-based protocols can improve quality by providing guidance on indications for tests or interventions. A related method is the use of care paths, also referred to as critical pathways or care pathways. These are management plans that additionally provide the sequence and timing of actions ...

Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review

“…Web-based interventions were analyzed most frequently at 8 of 38 occurrences (21%) [ 19 , 31 , 34 , 41 , 44 , 45 , 47 , 51 ]. Telemedicine and software programs were the next most frequently identified interventions, occurring 7 of 38 occurrences (18%) [ 16 - 18 , 21 , 32 , 40 , 46 ] and 6 of 38 occurrences (16%) [ 25 , 27 , 28 , 30 , 36 , 50 ], respectively. Clinical decision support systems were analyzed at a frequency of 5 of 38 occurrences (13%) [ 22 , 24 , 33 , 35 , 48 ].…”

“…The most common outcome category was physical, which appeared 39 of 65 occurrences (60%) [ 15 - 17 , 23 - 26 , 28 , 30 - 35 , 37 , 39 , 41 , 42 , 44 , 45 , 48 , 49 , 51 ]. The other two categories tied for second most often were as follows: psychological [ 17 - 19 , 21 , 27 , 40 , 47 ] and continuity of care [ 20 , 22 , 23 , 25 , 27 , 29 , 36 , 39 , 40 , 43 , 46 , 50 ], which each occurrences 13 of 65 occurrences (20%). Table 3 illustrates the categories of outcomes and the outcome results and their frequency of occurrence.…”

Comprehensive Telestroke Network to Optimize Health Care Delivery for Cerebrovascular Diseases: Algorithm Development

“…To the best of our knowledge, in our country, there are no software tools for the assessment and management of patients with stroke symptoms. Worldwide, smartphone apps and web-based tools are available [ 30 - 34 ]. These solutions were designed for acute ischemic stroke care, for triage protocols, and as an aid for transfers when reperfusion therapies are needed (eg, Field Assessment Stroke Triage for Emergency Destination score) [ 30 ] as well as the delivery of efficient inpatient or ambulatory stroke care [ 32 , 34 ].…”

Benefits of clinical facilitators on improving stroke care in acute hospitals: a new programme for Australia

“…12 However, in contrast to our study, their Facilitator role was not fixed-term and included patient management responsibilities. Previously, improved efficiency, quality of stroke care and in-hospital mortality have been demonstrated with the use of protocols or stroke care pathways, 23 and these were also important aspects implemented by Facilitators that contributed to the success of this programme. While the audit data were insufficient to detect changes in patient outcomes, our results remain important given the established associations between these aspects of care and the achievement of better health outcomes.…”

“…22 Even considering the multifactorial nature of implementation research, the qualitative data from stakeholders validated the view that the Facilitator was considered the catalyst in both the capacity-building elements of education and training and in driving wider organisational change, including dedicated staffing positions. Previously, improved efficiency, quality of stroke care and in-hospital mortality have been demonstrated with the use of protocols or stroke care pathways, 23 and these were also important aspects implemented by Facilitators that contributed to the success of this programme. Staff highlighted the importance of embedding new protocols and processes within the hospital system to ensure sustainability of improvements, rather than having changes dependent on a single person.…”