Abstract 12: National Surveillance of Stroke Quality of Care and Outcomes Using Post-stratification Survey Weights on the Get With the Guidelines-stroke Patient Registry

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Boback Ziaeian ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Ying Xian ◽  
Yosef Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Stroke Patient ◽  
Population Estimates ◽  
Maximum Weight ◽  
Get With The Guidelines ◽  
Post Stratification

Background: The U.S. lacks an appropriate stroke surveillance system. This study developed and validated post-stratification weights for an existing stroke patient registry to represent the entire U.S. population across the nine U.S. Census divisions. Methods: Two statistical approaches were used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample to model the burden of acute ischemic stroke. Post-stratification survey weights were estimated using a raking procedure and Bayesian interpolation methods. Both strategies for developing weights were compared. Weighting methods were adjusted to limit dispersion of weights and make reasonable national estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national population estimates were reported between the two post-stratification methods. Color treemaps were used to visualize the distribution of post-stratification weights across relevant sub-populations. Primary measures evaluated were patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results: There were a total of 1,388,296 acute ischemic strokes between 2012 and 2014. Raking and Bayesian estimates of clinical data not recorded in administrative databases were estimated within 5 to 10% of the margins of reference values. Median weights for the raking method were 1.366 and the weights at the 99 th percentile were 6.881 with a maximum weight of 30.775. Median Bayesian weights were 1.329 and the 99 th percentile weights were 11.201 with a maximum weight of 515.689. Conclusions: Leveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. Post-stratification weighting may be used as a basis for more advanced modeling relevant to understanding the burden of acute ischemic stroke and the quality of care delivered in U.S. hospitals. These methods may be applied to other diseases or settings to better monitor population health.

scholarly journals National Surveillance of Stroke Quality of Care and Outcomes by Applying Post-Stratification Survey Weights on the Get With The Guidelines-Stroke Patient Registry

2020 ◽  
Author(s):  
Boback Ziaeian ◽  
Haolin Xu ◽  
Roland A. Matsouaka ◽  
Ying Xian ◽  
Yosef Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Patient Characteristics ◽  
Care Quality ◽  
Maximum Weight ◽  
Get With The Guidelines ◽  
Post Stratification

Abstract Background: The U.S. lacks a stroke surveillance system. This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality.Methods: Two statistical approaches were used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample. Post-stratification survey weights were estimated using a raking procedure and Bayesian interpolation methods. Weighting methods were adjusted to limit the dispersion of weights and make reasonable epidemiologic estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national estimates were reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated were patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results: A total of 1,388,296 acute ischemic strokes occurred between 2012 and 2014. Raking and Bayesian estimates of clinical data not recorded in administrative databases were estimated within 5% to 10% of the margins of expected values. Median weights for the raking method were 1.386 and the weights at the 99th percentile were 6.881 with a maximum weight of 30.775. Median Bayesian weights were 1.329 and the 99th percentile weights were 11.201 with a maximum weight of 515.689. Conclusions: Leveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. These methods may be applied to other diseases or settings to better monitor population health.

scholarly journals National surveillance of stroke quality of care and outcomes by applying post-stratification survey weights on the Get With The Guidelines-Stroke patient registry

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Boback Ziaeian ◽  
Haolin Xu ◽  
Roland A. Matsouaka ◽  
Ying Xian ◽  
Yosef Khan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Patient Characteristics ◽  
Care Quality ◽  
Maximum Weight ◽  
Get With The Guidelines ◽  
Post Stratification

Abstract Background The U.S. lacks a stroke surveillance system. This study develops a method to transform an existing registry into a nationally representative database to evaluate acute ischemic stroke care quality. Methods Two statistical approaches are used to develop post-stratification weights for the Get With The Guidelines-Stroke registry by anchoring population estimates to the National Inpatient Sample. Post-stratification survey weights are estimated using a raking procedure and Bayesian interpolation methods. Weighting methods are adjusted to limit the dispersion of weights and make reasonable epidemiologic estimates of patient characteristics, quality of hospital care, and clinical outcomes. Standardized differences in national estimates are reported between the two post-stratification methods for anchored and non-anchored patient characteristics to evaluate estimation quality. Primary measures evaluated are patient and hospital characteristics, stroke severity, vital and laboratory measures, disposition, and clinical outcomes at discharge. Results A total of 1,388,296 acute ischemic strokes occurred between 2012 and 2014. Raking and Bayesian estimates of clinical data not available in administrative data are estimated within 5 to 10% of margin for expected values. Median weight for the raking method is 1.386 and the weights at the 99th percentile is 6.881 with a maximum weight of 30.775. Median Bayesian weight is 1.329 and the 99th percentile weights is 11.201 with a maximum weight of 515.689. Conclusions Leveraging existing databases with patient registries to develop post-stratification weights is a reliable approach to estimate acute ischemic stroke epidemiology and monitoring for stroke quality of care nationally. These methods may be applied to other diseases or settings to better monitor population health.

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

scholarly journals Al Ain Hospital in UAE maintains excellent standard of quality of care for acute ischemic stroke

2019 ◽  
Vol 405 ◽  
pp. 64-65
Author(s):  
R. Renganathan ◽  
M. Sunil ◽  
A. Jose ◽  
L. Joseph ◽  
A. Sabbah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Al Ain

Abstract P126: Regional Changes in Patterns of Stroke Presentation During the Covid-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mark R ETHERTON ◽  
Kori S Zachrison ◽  
Zhiyu Yan ◽  
Lukas Sveikata ◽  
Martin Bretzner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Stroke Patient ◽  
Care Delivery ◽  
Regional Analysis ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Patient Presentation

Introduction: Patterns of hospital presentation have changed during the COVID-19 pandemic. In stroke, delayed or avoided care may translate to substantial morbidity. We sought to determine the effect of the pandemic on patterns of stroke patient presentation and quality of care. Methods: We analyzed data from 25 New England hospitals: one urban, academic comprehensive stroke center (CSC) and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes and stroke admissions to the CSC from 11/1/2019 through 4/30/2020. We examined trends in stroke presentation including large vessel occlusion (LVO), alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- vs. post-3/1/2020, and used linear regression to examine trends over time. Results: Among 1248 patient presentations, telestroke consultations (0.4 fewer consults per week, p=0.005) and ischemic stroke patient admissions (decrease of 0.2 patients per week, p=0.04) decreased among the spokes and hub. Age and stroke severity were unchanged over the study period. We found no change in alteplase administration at telestroke spoke hospitals, but did note a decrease in both alteplase use (1.5 per week prior to March 1 st and 1 per week after, p=0.05) and thrombectomy at our CSC (0.1 fewer cases per week, p=0.02). Time metrics for patient presentation and care delivery were unchanged, however, rates of adherence for several quality measures were reduced during the pandemic (Table 1). Conclusions: In this regional analysis, we found decreasing telestroke consultations and ischemic stroke admissions, and reduced performance on stroke quality of care measures during the COVID-19 pandemic. Contrary to prior reports, we did not find an increase in thrombectomy nor decrease in clinical severity that might be expected if patients with milder symptoms avoided hospitalization.

Abstract WMP92: Quality of Care and Outcomes for Acute Ischemic Stroke Patients Admitted During the International Stroke Conference

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Steven R Messe ◽  
Michael T Mullen ◽  
Marguerrite Cox ◽  
Gregg Fonarow ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Stroke Patients ◽  
Time Periods ◽  
Iv Tpa

Introduction: Patients who present to the hospital during off-hours receive sub-optimal care and experience worse outcomes, often attributed to reduced staffing. It is unknown whether stroke patients receive less guideline-adherent care and experience worse outcomes when medical providers attend scientific meetings. The AHA International Stroke Conference (ISC) is the premier US conference for cerebrovascular disease and is well attended by stroke clinicians. Methods: The national Get With The Guidelines - Stroke (GWTG-Stroke) dataset was analyzed from 2009-2015 to identify acute ischemic stroke (AIS) patients admitted during: 1) the week of ISC, and 2) the 2 weeks before and 2 weeks after ISC. We compared adherence to GWTG-Stroke quality measures and outcomes for AIS patients admitted during these two time periods using univariable and multivariable analysis, including both patient and hospital level variables. Results: Overall, 69,738 AIS patients were included, mean age 72, 52% female, and 29% non-white. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non-ISC weeks (1,984 vs 1,997, p= 0.95). Patient and hospital characteristics were also similar between ISC vs. non-ISC time periods. No significant differences were noted in 14 quality of care metrics and 5 clinical outcomes between AIS patients treated during ISC vs. non-ISC weeks (Table). After adjusting for potential confounders, among patients who presented within 2 hours of onset there was no difference in the likelihood of receiving IV tPA within 3 hours (adjusted odds ratio 0.89, 95% confidence interval [CI] 0.77 - 1.03, p=0.13), nor in the likelihood of receiving IV tPA within 60 minutes of arrival (adjusted odds ratio 0.92, 95% CI 0.83 - 1.02, p=0.13). Conclusions: The treatment and outcome of patients who present with AIS to a GWTG-Stroke participating hospital are not degraded during the week of the International Stroke Conference.

Abstract 206: Pre-notification by Emergency Medical Services is Associated with More Timely Evaluation and Treatment of Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Cheryl Lin ◽  
Eric D Peterson ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
Li Liang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Get With The Guidelines

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent. Emergency medical services (EMS) pre-notification of stroke arrivals may provide a means of reducing evaluation and treatment times. In this study we used data from the nationwide Get With The Guidelines Stroke (GWTG-Stroke) program to determine the effect of EMS pre-notification on acute ischemic stroke processes of care. Methods: Acute ischemic stroke patients transported by EMS to 1585 GWTG-Stroke hospitals from April 2003 to March 2011 were studied. The association between EMS pre-notification and door-to-imaging (DTI) times, door-to-needle (DTN) times, onset-to-needle times (OTN), and tPA treatment rates were analyzed using multivariable GEE regression analyses. Results: Of 371,988 EMS transported acute ischemic stroke patients, EMS pre-notification occurred in 249,197 (67.0%). Patients with pre-notification had shorter door-to-imaging times, shorter onset-to-needle times, and were more likely to be treated with tPA when eligible ( Table ). EMS pre-notification was independently associated with increased odds of DTI ≤25 minutes (adjusted OR 1.53, 95% CI 1.44–1.63, p<0.0001), DTN times ≤60 minutes (aOR 1.20, 95% CI 1.10–1.31, p<0.0001), OTN times (aOR 1.17, 95% CI 1.09–1.25, p<0.0001), and tPA use within 3 hours among eligible patients arriving by 2 hours (aOR 1.64, 95% CI 1.50–1.79, p<0.0001), without significant increases in complications of thrombolytic therapy. Conclusion: EMS pre-notification is independently associated with more rapid patient imaging and increased timeliness in IV tPA administration. These results support the need for initiatives targeted at increasing EMS pre-notification rates as a mechanism from improving quality of care and outcomes in acute ischemic stroke.

Abstract 3029: Improved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke During Initial Implementation of the Get With The Guidelines-Stroke (GWTG-S) Program 2003-2008

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Sarah Song ◽  
Gregg C Fonarow ◽  
Wendy Pan ◽  
DaiWai M Olson ◽  
Adrian F Hernandez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Early Period ◽  
Stroke Care ◽  
Medicare Beneficiaries ◽  
Improvement Programs ◽  
Time Periods ◽  
Get With The Guidelines

Background: The first decade of the 21st century saw several changes in acute ischemic stroke care, including greater use of statins, tobacco cessation counseling, IV rt-PA, formally organized stroke centers, and national performance improvement programs. Changes in clinical outcomes from acute ischemic stroke during this period have not been fully delineated. Methods: We examined the national Medicare dataset to analyze clinical outcomes of ischemic stroke patients at hospitals joining Get With The Guidelines-Stroke (GWTG-Stroke) from April 1, 2003 to December 12, 2008. We designated three time periods of interest: 1) pre-period (6 months prior to GWTG-S participation, 2) early period (first 6 months of GWTG-Stroke participation), and 3) late period (6 to 18 months after GWTG-Stroke implementation). Clinical outcomes analyzed included discharge to home; inpatient, 30 day, and 1 year mortality; and 30 day and 1 year rehospitalization for stroke, cardiovascular event, and all cause. Results: 139,293 patients from 725 sites were included in the analysis. Mean age was 79.5 years, 41% male, 84% white. Patient demographics were similar across the three time periods, with minimal differences in comorbidities (e.g. diabetes, renal disease). Statistically significant changes between pre and late periods included: lower 30 day mortality (15.3% vs. 13.0%, p<.0001), lower 1 year mortality (28.0% vs 25.5%, p<.0001), lower stroke/TIA rehospitalization at 30 days (3.1% vs. 2.4%, p<.0001) and 1 year (9.2% vs. 8.7%, p<.002), lower rehospitalization for cardiovascular event at 30 days (2.9% vs. 2.3%, p<.0001) and 1 year (15.9% vs. 13.5%, p<.0001), and lower all cause rehospitalization at 30 days (17.4% vs. 15.1%, p<.0001) and 1 year (55.8% vs. 53.0%, p<.0001). Intermediate changes were seen during the early period. Rates of inpatient mortality and discharge to home did not change. Conclusions: During the first 2 years of participation, clinical outcomes for Medicare beneficiaries with acute ischemic stroke among hospitals joining GWTG-Stroke improved substantially, with 15% lower 30 day mortality rates and 24% lower 30 day rehospitalization rates for stroke or TIA. Further study is planned to determine if similar improvements in outcomes occurred at non-participating hospitals during this time frame.

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