Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Carol J Parker ◽  
Mathew J Reeves
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Base ◽  
Quality Metrics ◽  
Care Quality ◽  
Stroke Recurrence ◽  
The Impact ◽  
The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

Examining Organizational, Cultural, and Individual-Level Factors Related to Workplace Safety and Health Awareness and Risks: A Systematic Review and Metric Analysis (Preprint)

2018 ◽  
Author(s):  
Edmund W. J. Lee ◽  
Han Zheng ◽  
Htet Htet Aung ◽  
Megha Rani Aroor ◽  
Chen Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Citation Count ◽  
Workplace Safety ◽  
Key Factors ◽  
Health Awareness ◽  
Individual Level ◽  
Metric Analysis ◽  
Safety And Health ◽  
The Impact ◽  
The Relationship

BACKGROUND Promoting safety and health awareness and mitigating risks are of paramount importance to companies in high-risk industries. Yet, there are very few studies that have synthesized findings from existing online workplace safety and health literature to identify what are the key factors that are related to (a) safety awareness, (b) safety risks, (c) health awareness, and (d) health risks. OBJECTIVE As one of the first systematic reviews in the area of workplace health and safety, this study aims to identify the factors related to safety and health awareness as well as risks, and systematically map these factors within three levels: organizational, cultural, and individual level. Also, this review aims to assess the impact of these workplace safety and health publications in both academic (e.g., academic databases, Mendeley, and PlumX) and non-academic settings (e.g., social media platform). METHODS The systematic review was conducted in line with procedures recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). First, Proquest, ScienceDirect and Scopus were identified as suitable databases for the systematic review. Second, after inputting search queries related to safety and health awareness and risks, the articles were evaluated based on a set of inclusion and exclusion criteria. Third, the factors identified in the included articles were coded systematically. Fourth, the research team assessed the impact of the articles through a combination of traditional and new metric analysis methods: citation count, Altmetric Attention Score, Mendeley readers count, usage count, and capture count. RESULTS Out of a total of 4,831 articles retrieved from the three databases, 51 articles were included in the final sample and were systematically coded. The results revealed six categories of organizational (management commitment, management support, organizational safety communication, safety management systems, physical work environment, and organizational environment), two cultural (interpersonal support and organizational culture), and four individual (perception, motivation, attitude and behavior) level factors that relate to safety and health awareness and risk. In terms of impact, the relationship between citation count and the various metrics measuring academic activity (e.g., Mendeley readers, usage count, and capture count) were mostly significant while the relationship between citation count and Altmetric Attention Score was non-significant. CONCLUSIONS This study provides a macro view of the current state of workplace safety and health research and gives scholars an indication on some of the key factors of safety and health awareness and risks. Researchers should also be cognizant that while their work may receive attention from the scholarly community, it is important to tailor their communication messages for the respective industries they are studying to maximize the receptivity and impact of their findings. CLINICALTRIAL N.A.

Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

2021 ◽  
Author(s):  
Rachel A Prusynski ◽  
Allison M Gustavson ◽  
Siddhi R Shrivastav ◽  
Tracy M Mroz
Keyword(s):  
United States ◽  
Systematic Review ◽  
Patient Outcomes ◽  
Hospital Readmissions ◽  
The United States ◽  
Skilled Nursing Facilities ◽  
Functional Improvement ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

2021 ◽  
Author(s):  
Diane E. Twigg ◽  
Lisa Whitehead ◽  
Gemma Doleman ◽  
Sonia El‐Zaemey
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Nurse Staffing ◽  
The Impact

scholarly journals The health and relationship dynamics of late-life couples: a systematic review of the literature

2009 ◽  
Vol 29 (3) ◽  
pp. 455-480 ◽  
Author(s):  
RUTH B. WALKER ◽  
MARY A. LUSZCZ
Keyword(s):  
Systematic Review ◽  
Marital Quality ◽  
Late Life ◽  
The United States ◽  
Health It ◽  
Social Emotional ◽  
Marital Relations ◽  
The Impact ◽  
The Relationship ◽  
Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

Gritty Leaders: The Impact of Grit on Positive Leadership Capacity

2018 ◽  
Vol 122 (4) ◽  
pp. 1449-1470 ◽  
Author(s):  
Sarah E. Schimschal ◽  
Tim Lomas
Keyword(s):  
Leadership Practices ◽  
Evidence Base ◽  
Leadership Capacity ◽  
Three Dimensions ◽  
Leadership Strategies ◽  
Self Assessment ◽  
Positive Leadership ◽  
Convenience Sampling ◽  
The Impact ◽  
The Relationship

The concepts of grit and positive leadership are central to extraordinary performance. However, to date there has been little empirical analysis of the relationship between a leader’s level of grit and their capacity to implement positive leadership strategies and practices. This correlational study explores these linkages, taking grit subfactors into consideration as well as three dimensions of positive leadership. Convenience sampling was used to survey 100 leaders across a range of industries. Respondents completed the Grit Scale and 18 questions from the Positive Leadership Practices Self-Assessment. Results indicated that grit positively correlated with positive leadership, and perseverance exhibited a stronger relationship than passion. Further, grit accounted for variance in positive leadership. These findings provide a solid evidence base for giving leaders access to development opportunities that can accelerate the growth of grit and positive leadership.

Abstract TMP86: Telestroke Improves Guideline-Based Comprehensive Stroke Care: The TELECAST Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Christopher D Streib ◽  
Oladi Bentho ◽  
Kathryn Bard ◽  
Eric Jaton ◽  
Sarah Engkjer ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Composite Score ◽  
Stroke Recurrence ◽  
Acute Stroke Care ◽  
Specialist Service ◽  
Stroke Treatment ◽  
Chi Squared ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Limited access to stroke specialist expertise produces disparities in inpatient stroke treatment. The impact of telestroke on the remote delivery of guideline-based inpatient stroke care is yet to be comprehensively studied. The TELECAST trial (NCT03672890) prospectively examined the impact of a 24-7 telestroke specialist service dedicated to inpatient acute stroke care spanning admission to discharge. Methods: AHA stroke guidelines were used to derive outcome metrics in the following acute stroke inpatient care categories: diagnostic stroke evaluation (DSE), secondary stroke prevention (SSP), health screening and evaluation (HSE), and stroke education (SE). Adherence to AHA guidelines for stroke inpatients pre-telestroke (July 1, 2016-June 30, 2018) and post-telestroke intervention (July 1, 2018-June 30, 2019) were studied. The primary outcome was a composite score of all guideline-based stroke care. Secondary outcomes consisted of subcategory composite scores in DSE, SSP, HSE, and SE. Chi-squared tests were utilized to assess primary and secondary outcomes. Statistical analysis was performed using STATA 15.0. Results: Following institution of a comprehensive inpatient telestroke service, overall adherence to guideline-based metrics improved (composite score: 85% vs 94%, p<0.01) as did adherence to DSE guidelines (subgroup score: 90 vs 95%, p<0.01). SSP, HSE, and SE subgroup scores were not significantly different. See Table 1. Conclusion: The implementation of a 24-7 inpatient telestroke service improved adherence to AHA guidelines for inpatient acute stroke care. Dedicated inpatient telestroke specialist coverage may improve inpatient stroke care and reduce stroke recurrence in hospitals without access to stroke specialists.

Family interventions in psychosis

2020 ◽  
pp. 531-537
Author(s):  
Juliana Onwumere ◽  
Elizabeth Kuipers
Keyword(s):  
Patient Outcomes ◽  
Family Involvement ◽  
Lived Experiences ◽  
Treatment Guidelines ◽  
Well Being ◽  
Evidence Base ◽  
Family Interventions ◽  
Improved Outcomes ◽  
The Impact

Families can play an important role in supporting individuals living with psychosis disorders and helping to facilitate their improved outcomes. This chapter, offered by Juliana Onwumere and Elizabeth Kuipers, provides an overview of the literature reporting on family involvement in the care of adults with lived experiences of psychosis, the impact of the caregiving role on carer well-being, and the predictive links between caregiving relationships and key patient outcomes including relapse. The chapter reports on the application of family interventions, the evidence base supporting its application and inclusion in treatment guidelines, and implementation issues.

Sign in / Sign up

Export Citation Format

Share Document