Establishing Standard Performance Measures for Adult Stroke Patients: A Nationwide Inpatient Sample Database Study

Introduction/Hypothesis: We were interested in studying patient outcomes with acute cerebrovascular disease (ACVD) who had concomitant acute or chronic renal insufficiency (RI). Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (1998-2009) and identified 1,760,415 adult ACVD patients among 92,848,710 patients enrolled. Using SAS 6.4 and applying SPSS 22 the outcome variables mortality, length of hospital stay (LOS), HC (HC) >$20,000, and disposition (home or any care facility) were selected. Logistic regression analyses were performed adjusting for the covariates hypertension (HTN), diabetes mellitus (DM), age, race, sex, number of comorbidities, and care complexity (numbers of inpatient procedures) among all ACVD with and without RI. Results: Mean age was 71 years (SD 15) with 76% >65 years old; 54% female gender; 55% Whites, 11% Blacks, 6% Hispanics. Among all ACVD, 66% had HTN, 28% DM, RI 9%, LOS 7.6 days (SD 9.8), in-patient mortality 12%; disposition home 42% and facility 44%, and mean HC $36,010 (SD $63,331). After covariate adjustment, the mortality rate of ACVD patients with RI was 24% vs 11% (P<0.001) for those without RI; LOS ≥7 days 50% vs 29% (P<0.001); and facility discharge 62% vs 51% (P<0.001). In subgroup analysis, adjusted HC were significantly greater in patients with acute RI (78% vs 43%; P<0.001). The frequency of hemodialysis (HD) in all ACVD patients was 2.3%. Notably, HD was associated with LOS ≥7 days (61% vs 30%; p<0.001), increased mortality rate (25% vs 12%; p<0.001), and HC (76% vs 44%; p<0.001). However, there was no difference in disposition to facility (57% vs 52%; p<0.350). Conclusions: Acute or chronic RI was present in 9% of patients with ACVD. RI was associated with significantly greater risks of in-patient mortality, LOS, and discharge to a facility. In subgroup analyses, the overall HC were greater in patients with acute RI. Patients undergoing HD experienced a similar negative impact on all outcome parameters except for disposition status. The negative impact of RI on vital outcome parameters in ACVD patients should be considered, i.e., when indicating the administration of contrast for imaging.

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Robotic vs Laparoscopic Surgery for Rectal Cancer: A Look at the Nationwide Inpatient Sample Database

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2018.07.156 ◽

2018 ◽

Vol 227 (4) ◽

pp. S75

Author(s):

Mark A. Jayanathan ◽

Marcus B. Fluck ◽

Kevin C. Long ◽

Christopher J. Buzas ◽

Kristen Halm ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Nationwide Inpatient Sample ◽

Nationwide Inpatient Sample Database

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Abstract WP237: Improved Thrombolysis Rates and Quality of Care for Stroke Patients Through a Provincial Emergency Department Quality Improvement Initiative

Stroke ◽

10.1161/str.44.suppl_1.awp237 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Devin R Harris ◽

Robert Stenstrom ◽

Eric Grafstein ◽

Mark Collison ◽

Grant Innes ◽

...

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Of Care ◽

Performance Measures ◽

Large Scale ◽

Primary Outcome ◽

Baseline Data ◽

Quality Improvement Initiative ◽

Stroke Patients

Background: The care of stroke patients in the emergency department (ED) is time sensitive and complex. We sought to improve quality of care for stroke patients in British Columbia (B.C.), Canada, emergency departments. Objectives: To measure the outcomes of a large-scale quality improvement initiative on thrombolysis rates and other ED performance measures. Methods: This was an evaluation of a large-scale stroke quality improvement initiative, within ED’s in B.C., Canada, in a before-after design. Baseline data was derived from a medical records review study performed between December 1, 2005 to January 31, 2007. Adherence to best practice was determined by measuring selected performance indicators. The quality improvement initiative was a collaboration between multidisciplinary clinical leaders within ED’s throughout B.C. in 2007, with a focus on implementing clinical practice guidelines and pre-printed order sets. The post data was derived through an identical methodology as baseline, from March to December 2008. The primary outcome was the thrombolysis rate; secondary outcomes consisted of other ED stroke performance measures. Results: 48 / 81 (59%) eligible hospitals in B.C. were selected for audit in the baseline data; 1258 TIA and stroke charts were audited. For the post data, 46 / 81 (57%) acute care hospitals were selected: 1199 charts were audited. The primary outcome of the thrombolysis rate was 3.9% (23 / 564) before and 9.3% (63 / 676) after, an absolute difference of 5.4% (95% CI: 2.3% - 7.6%; p=0.0005). Other measures showed changes: administration of aspirin to stroke patients in the ED improved from 23.7% (127 / 535) to 77.1% (553 / 717), difference = 53.4% (95% CI: 48.3% - 58.1%; p=0.0005); and, door to imaging time improved from 2.25 hours (IQR = 3.81 hours) to 1.57 hours (IQR 3.0), difference = 0.68 hours (p=0.03). Differences were found in improvements between large and small institutions, and between health regions. Conclusions: Implementation of a provincial emergency department quality improvement initiative showed significant improvement in thrombolysis rates and adherence to other best practices for stroke patients. The specific factors that influenced improvement need to be further explored.

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