Abstract 306: Regional Differences in Stroke Center Designation and Get with The Guidelines (GWTG-S) Participation and Performance: Results From The NorthEast Cerebrovascular Consortium (NECC)

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Toby I Gropen ◽  
Charles R Wira ◽  
Shannon Melluzzo ◽  
Zainab Magdon-Ismail ◽  
David Day ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Census Data ◽  
Systems Of Care ◽  
Care Providers ◽  
Performance Achievement ◽  
Primary Stroke Center ◽  
And Performance ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Over Time

Introduction: The NorthEast Cerebrovascular Consortium (NECC) was created in 2006 to unite health care providers, public health officials, legislators and advocacy organizations in an 8-state region to implement and assess a Stroke Systems of Care Model. Objectives: To examine differences in Primary Stroke Center (PSC) designation, participation in GWTG-S and performance of acute care hospitals (ACH) and critical access centers (CAC) in the NECC region compared to non-NECC regions. Methods: We compared percentages of ACHs/CACs with State versus National PSC Designation, GWTG-S participation and Performance Achievement award trends over time in the pre- (2005) and post- NECC (2006-13) time periods. State designation refers to states conducting designation themselves or a combination of their own designation/national designation (Joint Commission, DNV or HFAP). US census data regions were stratified as The NECC region (CT, MA, ME, NH, NJ, NY, RI, VT) vs. Non-NECC regions (PA, South, Midwest, West). ACH/CACs were obtained from CMS. GWTG-S data were used for GWTG-S participation and awards (silver or higher for >1 year). Results: Over the study time period (2005-13) the ACH/CACs per year in The NECC and non-NECC regions were 433 + 10 and 4420 + 172. State PSC designation occurred in CT, MA, FL, MD, NJ, and NYS. OK State designation was excluded due to lack of data. In the NECC region, State PSC designation increased over time from 29.3% in 2005 to 63.2% in 2013, compared to 0.1% in 2005 to 3.6% in 2013 in non-NECC regions (both analyses p<0.0001, Cochran Armitage Trend (CAT)). In the NECC region, National PSC designation increased over time from 2.8% in 2005 to 17.1% in 2013, compared to 35.5% in 2005 to 77.3% in 2013 in non-NECC regions (both analyses p<0.0001, CAT). In the NECC region, GWTG-S participation increased over time from 21.2% in 2005 to 61.5% in 2013 compared to 9.2% in 2005 to 32.4% in 2013 in non-NECC regions (both analyses p<0.0001, CAT), and GWTG-S awards increased over time in the NECC region from 0.5% in 2005 to 42.5% in 2013 compared to 0.1% in 2005 to 16.6% in 2013 in non-NECC regions (both analyses p<0.0001, CAT). After adjusting for year, significantly more NECC ACH/CACs received State PSC designation and significantly more non-NECC ACH/CACs received National PSC designation (both analyses p<0.0001, Cochran-Mantel-Haenszel (CMH)). Significantly more NECC ACH/CACs participated in GWTG-S and received GWTG-S awards than non-NECC ACH/CACs (both analyses p<0.0001, CMH). Conclusions: There has been more rapid growth of State in lieu of National PSC certification, and participation and achievement in GWTG-S in the Northeast from 2006 through 2013 compared to other regions in the U.S. The NECC may compliment and enhance existing regulatory and advocacy initiatives. Further investigation is merited to evaluate the influence of regional networks and State versus National PSC designation.

Abstract W P286: Assessing Wisconsin Hospitals’ Capacity to Treat Acute Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Julie E Baumann
Keyword(s):  
Acute Stroke ◽  
Technical Assistance ◽  
Systems Of Care ◽  
Stroke Care ◽  
Self Report ◽  
The Status ◽  
Primary Stroke Center ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Reported Data

Introduction: Establishing regional stroke systems of care can improve timely treatment and survival, and reduce disability and related healthcare costs for persons experiencing acute stroke. A well-functioning stroke system requires seamless coordination between EMS, hospitals and certified stroke centers. Of 127 non-specialty hospitals in Wisconsin, 2% are comprehensive stroke centers and 24% have achieved primary stroke center certification. However, little is known about other hospitals’ capacity to treat acute stroke. The Wisconsin Stroke Coalition (WSC) wanted to better understand the need to improve stroke care capacity among hospitals not certified to treat stroke. The hypothesis was that few non-stroke certified hospitals in Wisconsin have all the criteria in place to treat acute stroke. Methods: WSC developed a short survey based on the Brain Attack Coalition’s recommendations for an acute stroke-ready hospital (ASRH). The tool included a user-friendly checklist that captured the status of each recommendation; in place currently or within six months; could be developed with assistance; or no plan to develop. WSC distributed the survey to 88 non-specialty, non-stroke certified hospitals and requested that each self-report their level of stroke care. Results: Fifty-nine percent of hospitals responded to the survey. Among respondents, 5% reported having all recommendations in place within six months, 53% reported having some of the recommendations in place and 1% reported no plan to develop any of the recommendations. While only a few had implemented every recommendation, the majority either had in place or were receptive to adopting individual suggestions. Nearly half of respondents reported having telestroke in place (either by phone, with video, or both). Conclusions: According to self-reported data, non-specialty, non-stroke certified hospitals in Wisconsin appear well-positioned or receptive to developing basic recommendations for acute stroke-ready hospitals. WSC plans to disseminate findings to Wisconsin hospitals and gather further information about technical assistance that would improve their level of stroke care and coordination with EMS.

Abstract WP340: Impact of Increasing Primary Stroke Center Transfers on Comprehensive Stroke Center Capacity

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jane Holl ◽  
Andy Cai ◽  
Lauren Ha ◽  
Alin Hulli ◽  
Melina Paan ◽  
...  
Keyword(s):  
Systems Of Care ◽  
Vessel Occlusion ◽  
Capacity Limits ◽  
Transfer Rates ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Systems Of Care ◽  
Stroke Center ◽  
Occupancy Rates ◽  
Bed Occupancy Rates

Introduction: Given the time-sensitive benefits of acute stroke (AS) treatments, stroke systems of care must balance reducing door-in-door-out (DIDO) time at primary stroke centers (PSCs) with capacity limits at comprehensive stroke centers (CSCs). For example transferring more AS patients earlier in the process (e.g., prior vascular imaging for large vessel occlusion) from PSCs would result in more inappropriate transfers to CSCs that could overburden these centers.We conducted a simulation to estimate the balance between increased AS transfers from PSCs to CSCs and the percent of CSC time on “bypass” (inability to accept transfers to neuro-ICU). Methods: Clinicians from 3 Chicago-area CSCs and 3 affiliated PSCs and the Chicago Emergency Medical Services (EMS) created a PSC DIDO process map. We assumed CSC time on bypass is affected by AS and non-AS admissions from the CSC and from the affiliated PSCs. Input data were obtained fromtheChicago region registry (e.g., # PSC to CSC transfers), peer reviewed literature (US average transfer rate of AS patients to CSCs), EMS (PSC-CSC affiliations), and CSCs (e.g., average bed occupancy rates). CSC size was estimated by #neuro-ICU beds: small (12 beds), medium (23 beds), and large (28 beds). The simulation output was % time of CSC on “bypass”. Results: Table shows % time of CSC on bypass by varying PSC AS transfer rates for each category of CSC size. Larger increases in PSC transfer rates resulted in modest increases in CSC bypass rates, particularly for medium and large CSCs. Validation with data from one CSC showed < 4% overestimate of CSC % time on bypass. Conclusion: CSCs with more beds have efficiencies of scale leading to lower % time on bypass, even with increases in PSC AS transfer rates proportionate to CSC size. This model allows stroke systems of care to compute regional CSCs’ % time on bypass based on actual PSCs’ transfer rates and CSC size.

Abstract P862: Successes and Impact of a Statewide Stroke Education Campaign for Healthcare Providers

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Olivia N Jones ◽  
Janna Pietrzak ◽  
Kylie Picou ◽  
Mindy Cook ◽  
Adela Santana ◽  
...  
Keyword(s):  
North Dakota ◽  
Health Care Providers ◽  
Healthcare Professionals ◽  
Life Support ◽  
Systems Of Care ◽  
Everyday Practice ◽  
Care Providers ◽  
Stroke Patients ◽  
Treatment Methods ◽  
The Impact

Introduction: The North Dakota Mission: Lifeline Stroke program is a 3-year initiative which aims to improve statewide stroke systems of care. Due to complexities in recognizing and treating stroke patients, effective education of prehospital and hospital health care providers on guideline-based assessments and treatment methods were identified as an essential intervention. In person lectures, conferences, workshops, stroke simulation trainings, online courses, webinars, and a stroke certification program were deployed throughout the project. Purpose: The purpose of the post-education survey was to determine the impact, value, and success of different types of education provided during the project. Methods: North Dakota healthcare professionals (n=221) completed a 20-question online survey about their experiences participating in the stroke trainings provided from 2017 to 2020. Results: Survey respondents consisted of 76 Emergency Medical Service (EMS) providers and 145 hospital-based healthcare professionals. The majority of hospital-based staff respondents were nurses (80.1%), while most EMS-based respondents were paramedics or EMTs (75.0%). Half of all respondents (49.8%) participated in 2 or more educational offerings. Respondents were asked to rank the educational offerings in which they participated in by order of the benefit to their everyday practice. The two highest ranking educational offerings were the Advanced Stroke Life Support Class (mean rank=1.6) and Simulation in Motion (SIM) ND (mean rank=2.3). More than 90% of respondents stated that these trainings were extremely or very applicable to their everyday practice. When asked about the overall impact of all the educational offerings they participated in, almost all (92.6%) respondents indicated they agree that because of the trainings they have a better understanding of the key issues related to caring for stroke patients. Conclusions: Overall, the comprehensive survey provides concrete evidence and feedback that multi-modal education campaigns are well-received and effective in furthering awareness of guideline-based stroke assessments and treatment methods. Activities with a kinesthetic learning approach were found to be especially well-received.

Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Evan Kolesnick ◽  
Evan Kolesnick ◽  
Alfredo Munoz ◽  
Kaiz Asif ◽  
Santiago Ortega‐Gutierrez ◽  
...  
Keyword(s):  
United States ◽  
Acute Stroke ◽  
Clinical Outcomes ◽  
Healthcare Disparities ◽  
Systems Of Care ◽  
Stroke Care ◽  
The United States ◽  
Time Dependent ◽  
Stroke Systems Of Care ◽  
Stroke Center

Introduction : Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods : Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results : Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions : Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States.

scholarly journals New Syphilis Cases in Older Adults, 2004–2019: An Analysis of Surveillance Data From South China

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng Wang ◽  
Peizhen Zhao ◽  
Mingzhou Xiong ◽  
Joseph D. Tucker ◽  
Jason J. Ong ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Temporal Trends ◽  
Health Concern ◽  
Targeted Prevention ◽  
Care Providers ◽  
Annual Percent Change ◽  
Syphilis Infection ◽  
Over Time

Background: Sexual health among older adults is a major public health concern globally. The syphilis burden is increasing in older adults in China. This study aimed to describe factors associated with syphilis infection and diagnosis among older adults in China during a 16 year period.Methods: Using 16 years of data (2004–2019) from the syphilis case report system of Guangdong, China, we compared data from older adults (aged ≥50 years) with those from younger people (aged 15–49 years). We compared the two age group with the Chi-square test for difference, and Joinpoint regression models to assess the temporal trends.Results: During the study period, 242,115 new syphilis diagnoses were reported in older adults. The mean notification rate of new diagnoses was 64.1 per 100,000 population across the entire 16-year period, which significantly increased over time (average annual percent change [AAPC] 16.2%, 95% CI 13.7–18.7). Syphilis diagnoses increased significantly over time among less developed cities and older women. In 2019, compared with younger adults, newly diagnosed older adults were more likely to be male, native to reporting city, had unknown transmission routes, and were diagnosed late.Conclusion: Our findings call for an urgent need to deliver more targeted prevention interventions for older adults, such as strengthen awareness among health care providers, and integration of syphilis services and primary health care for older adults.

scholarly journals Nurses’ Knowledge, Attitude, and Performance about Disaster Management: A Case of Iran

2020 ◽  
Vol 13 (1) ◽  
pp. 441-446
Author(s):  
Sedighe S. T. Far ◽  
Milad A. Marzaleh ◽  
Nasrin Shokrpour ◽  
Ramin Ravangard
Keyword(s):  
Disaster Management ◽  
Health Care Providers ◽  
Work Experience ◽  
Three Dimensions ◽  
Teaching Hospitals ◽  
Care Providers ◽  
Medical Sciences ◽  
Significant Relationships ◽  
The Mean ◽  
And Performance

Background: Iran is a disaster-prone country in which many natural and man-made disasters happen every year. Because the health sector is vital due to its nature of treatment and rehabilitation of the injured after the disasters, all health care providers, especially hospital nurses, should be prepared to provide the services they need. Objective: The present study aimed to determine the level of knowledge, attitude, and performance of nurses about disaster management in teaching hospitals affiliated to Iran, Shiraz University of Medical Sciences in 2019. Methods: This cross-sectional and descriptive-analytical study was conducted on a sample of 230 nurses working in the teaching hospitals of Iran, Shiraz University of Medical Sciences, who were selected using the stratified sampling proportional to size and simple random sampling methods. The data were collected using a valid and reliable questionnaire containing 20 questions in three dimensions of knowledge, attitude, and performance. Then, the collected data were analyzed using SPSS 25.0 through independent samples t-test, ANOVA and Tukey tests at the significance level of 5%. Results: The results showed that the highest and lowest mean scores were related to the attitude (2.38±0.19) and knowledge (1.70±0.50) of the nurses, respectively. However, all three dimensions were at a moderate level. The results showed significant relationships between the mean score of performance and the gender, marital status, age, and work experience of the nurses. In addition, statistically significant relationships were found between the mean score of knowledge and their age and work experience (p<0.05). Conclusion: According to the findings, the following suggestions can be made to increase the knowledge and performance of the nurses for being prepared in critical situations: reducing the duration and increasing the quality of training classes and workshops on disaster preparedness; providing some incentives for nurses, especially female, married, older, and more experienced ones to attend these classes; and improving the methods of training materials related to disaster management.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

The Impact of the New Rural Cooperative Medical Scheme on Township Hospitals' Utilization and Income Structure in Weifang Prefecture, China

2018 ◽  
pp. 109-121
Author(s):  
Martine Audibert ◽  
Jacky Mathonnat ◽  
Aurore Pélissier ◽  
Xiao Xian Huang
Keyword(s):  
Health Care Providers ◽  
Positive Impact ◽  
Care Providers ◽  
Representative Survey ◽  
Key Stakeholders ◽  
Hospitalization Costs ◽  
Cooperative Medical Scheme ◽  
Township Hospitals ◽  
The Impact ◽  
Over Time

The New Rural Cooperative Medical Scheme was gradually introduced from 2003 in China. This paper is based on a representative survey of 24 randomly selected township hospitals in Weifang prefecture over the period 2000-2008. Using a generalized form of differences-in-differences model, it aims to assess the effect of the reform on the utilization and income structure of the township hospitals. The estimations provide three main results linked to the effects of the New Rural Cooperative Medical Scheme on the behavior of the key stakeholders (households, health care providers and Health Bureau). Firstly, the reform had positive impacts on the utilization of township hospitals, particularly on the inpatient activity, but no significant impact on their income structure. Secondly, a decrease in the burden of hospitalization costs for households is suggested by the higher positive impact of the reform on the volume of inpatients in poor areas than in the other ones. Lastly, the marginal impact of the reform decreases over time.

A comparative analysis of two alternative programmes to counter stigma and discrimination associated with mental illness delivered to medical students

2020 ◽  
pp. 103985622097193
Author(s):  
Sarah E Gordon ◽  
Leah A Kininmonth ◽  
Giles Newton-Howes ◽  
Gordon L Purdie ◽  
Tracey Gardiner
Keyword(s):  
Medical Students ◽  
Health Care Providers ◽  
Mental Distress ◽  
Healthcare Providers ◽  
Care Providers ◽  
Stigma And Discrimination ◽  
Positive Attitudes ◽  
Effective Contact ◽  
Students Attitudes ◽  
Over Time

Objective: To assess and compare attitudes of medical students in response to two service-user-led anti-stigma and discrimination education programmes. Method: Two programmes, consistent with the key elements of effective contact-based anti-stigma and discrimination education programmes for healthcare providers, were delivered to medical students in their penultimate and final year: a more intensive version of the programme in 2015/2016 and a briefer programme in 2016/2017. Attitudes were assessed using the Recovery Attitudes Questionnaire (RAQ) and the Opening Minds Stigma Scale for Health Care Providers (OMS-HC-20) at the beginning and end of their final year. Results: There were no significant differences between the years in initial scores on either scale. Both cohorts showed statistically significant reductions in scores on both scales after completion of the programme, indicating overall improvements in students’ attitudes with reductions in stigma, and more positive attitudes towards recovery of those in mental distress. The more intensive programme led to significantly greater improvement in reductions in stigma than the less intensive programme. Conclusion: Findings support the need for contact-based anti-stigma and discrimination education programmes for medical students that are both intensive and repeated over time.

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