Processes of Care Associated With Acute Stroke Outcomes

Bravata, Dawn M.; Wells, Carolyn K.; Lo, Albert; Nadeau, Steven E.; Melillo, Jean; Chodkowski, Diane; Struve, Frederick A.; Williams, Linda S.; Peixoto, Aldo J.; Gorman, Mark; Goel, Pankaj; Acompora, Gregory; McClain, Vincent; Ranjbar, Noshene; Tabereaux, Paul B.; Boice, John L.; Jacewicz, Michael; Concato, John

doi:10.1001/archinternmed.2010.92

Cited by 62 publications

(58 citation statements)

References 28 publications

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“…We performed a secondary analysis of data derived from a retrospective cohort study that evaluated medical records through chart review of patients with an ischemic stroke or transient ischemic attack (TIA) admitted to one of two Department of Veterans Affairs (VA) or one of two non-VA hospitals between 1998 and 2003 [28]. We included veterans and nonveterans in the original parent study if they had an acute ischemic stroke or TIA, had neurological symptom onset within 2 days of admission, had a neurological deficit on admission (National Institutes of Health Stroke Scale [NIHSS] 2), and were 18 years old.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Schmid¹,

Wells²,

Concato³

et al. 2010

JRRD

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Abstract-Falls are a serious medical complication following stroke. The objectives of this study were to (1) confirm the prevalence of falls among patients with stroke during acute hospitalization, (2) identify factors associated with falls during the acute stay, and (3) examine whether in-hospital falls were associated with loss of function after stroke (new dependence at discharge). We completed a secondary analysis of data from a retrospective cohort study of patients with ischemic stroke who were hospitalized at one of four hospitals. We used logistic regression to identify factors associated with inpatient falls and examine the association between falls and loss of function. Among 1,269 patients with stroke, 65 (5%) fell during the acute hospitalization period. We found two characteristics independently associated with falls: greater stroke severity (National Institutes of Health Stroke Scale [NIHSS] 8, adjusted odds ratio [OR] = 3.63, 95% confidence interval [CI]: 1.46-9.00) and history of anxiety (adjusted OR = 4.90, 95% CI: 1.70-13.90). Falls were independently associated with a loss of function (adjusted OR = 9.85, 95% CI: 1.22-79.75) even after adjusting for age, stroke severity, gait abnormalities, and past stroke. Stroke severity (NIHSS 8) may be clinically useful during the acute inpatient setting in identifying those at greatest risk of falling. Given the association between falls and poor patient outcomes, rehabilitation interventions should be implemented to prevent falls poststroke.Abbreviations: ADL = activity of daily living, CI = confidence interval, IADL = instrumental activity of daily living, NIHSS = National Institutes of Health Stroke Scale, OR = odds ratio, SD = standard deviation, TIA = transient ischemic attack, UTI = urinary tract infection, VA = Department of Veterans Affairs.

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Section: Methodsmentioning

confidence: 99%

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Schmid¹,

Wells²,

Concato³

et al. 2010

JRRD

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“…Studies have found association between process of care performance measures and mortality outcomes for patients with cardiovascular disease and stroke. 30,31 It is certainly possible that improved guideline-based treatment, more frequent thrombolytic therapy, enhanced secondary prevention and risk factor management, early rehabilitation and patient education programs may also be responsible for the lower mortality rates among patients treated at stroke centers. However, these efforts may not have any appreciable shortterm or immediate life-saving effect, which is consistent with our findings of minimal mortality difference at day 1 and similar readmission rates at 30 days compared to greater survival benefit at the end of 1 year follow-up.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Xian¹,

Holloway²,

Chan³

et al. 2012

Survey of Anesthesiology

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Context-Although stroke centers are widely accepted and supported, little is known about their impact on patient outcomes.Objective-To examine the association between admission to stroke centers for an acute ischemic stroke and mortality.Design, Setting, and Participants-Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n=30,947) between 2005 and 2006 at designated stroke centers and non-designated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential pre-hospital selection bias. Patients were followed for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n=39,409) or acute myocardial infarction (n=40,024) at designated stroke centers and nondesignated hospitals.Main Outcome Measure-Thirty-day all-cause mortality.Correspondence: Ying Xian, MD, PhD; Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705; Tel: (585) Fax: (919) 668-7058; ying.xian@duke.edu. AUTHOR CONTRIBUTIONS Dr Xian had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Previous Presentation:This study was presented in part at the 2010 American Heart Association Quality of Care and Outcomes Research Conference, Washington, DC, May 20, 2010 Role of the Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHA and AHRQ.Disclaimer: This study used a linked SPARCS-SSADMF database. The interpretation and reporting of these data are the sole responsibility of the authors. Results-Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with greater use of thrombolytic therapy (4.8% vs. 1.7%; adjusted difference 2.2%, 95% CI, 1.6% to 2.8%; P<0.001) and lower 30-day all-cause mortality (10.1% vs. 12.5%; adjusted mortality difference: −2.5%, 95% CI, −3.6% to −1.4%; P<0.001). Differences in mortality also were observed at all time points, including at 1-day, 7-day, and 1-year follow-up. Moreover, the outcome differences were specific to stroke, as stroke centers and non-stroke centers had similar 30-day all-cause mortality rates among those with acute myocardial infarction (adjusted mortality difference: +0.3%, 95% CI, −0.5% to 1.0%; P=0.50) and/or gastrointestinal hemorrhage (adjusted mortality difference: +0.1%, 95% CI, −0.9% to 1.1%; P=0.83). NIH Public AccessConclusions-Admission to a designated stroke center for acute isc...

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“…(12) Briefly, this retrospective cohort included patients who were admitted with ischemic stroke or TIA at any of three VA or two non-VA hospitals, during the years 1998-2003, if they had a neurological symptom onset within 2 days of admission, had a neurological deficit on admission (rNIHSS ≥ 2), and were at least 18-years old. Patients were excluded from the QUEST study if they were residing in a skilled nursing facility at the time of stroke symptom onset, were already admitted to the hospital at the time of stroke symptom onset, were transferred from another acute care facility, or were not admitted to the hospital.…”

Section: Patients and Settingmentioning

confidence: 99%

Using Radiological Data to Estimate Ischemic Stroke Severity

Sico

Phipps

Concato

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Goal: Risk-adjusted post-stroke mortality has been proposed for use as a measure of stroke care quality. Although valid measures of stroke severity (e.g., the NIH Stroke Scale) are not typically available in administrative datasets, radiology reports are often available within electronic health records. We sought to examine whether admission head computed tomography data could be used estimate stroke severity. Materials and Methods:Using chart review data from a cohort of acute ischemic stroke patients (1998)(1999)(2000)(2001)(2002)(2003), we developed a radiographic measure (Brain Imaging Score) of stroke severity in a two-thirds development set and assessed in a one-third validation set. The retrospective NIH Stroke Scale was dichotomized as: mild/moderate (<10) and severe (≥10). We compared the association of this radiographic score with NIH Stroke Scale and in-hospital mortality at the patient-level. Findings:Among 1348 stroke patients, 86.5% had abnormal findings on initial head computed tomography. The c-statistic for the Brain Imaging Score for modeling severe stroke (development, 0.581; validation, 0.579) and in-hospital mortality (development, 0.623; validation, 0.678) were generated. Conclusion:Although the c-statistics were only moderate, the BIS provide significant risk stratification information with a two-variable score. Until administrative data routinely includes a valid measure of stroke severity, radiographic data may provide information for use in risk adjustment.4

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Processes of Care Associated With Acute Stroke Outcomes

Abstract: Outcomes among patients with ischemic stroke or TIA can be improved by attention to swallowing function, DVT prophylaxis, and treatment of hypoxia.

Cited by 62 publications

References 28 publications

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting

Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

Using Radiological Data to Estimate Ischemic Stroke Severity

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