scholarly journals Metrics for Measuring Quality of Care in Comprehensive Stroke Centers: Detailed Follow-Up to Brain Attack Coalition Comprehensive Stroke Center Recommendations

Stroke ◽  
2011 ◽  
Vol 42 (3) ◽  
pp. 849-877 ◽  
Author(s):  
Dana Leifer ◽  
Dawn M. Bravata ◽  
J.J. (Buddy) Connors ◽  
Judith A. Hinchey ◽  
Edward C. Jauch ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Abstract WMP88: Shorter Door-to-Needle Times of Intravenous Alteplase Improve “Efficiency” of Care and Moderately Affect “Quality” of Care: Study Based on a Large Comprehensive Stroke Center

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Suja S Rajan ◽  
Jessica N Wise ◽  
Marquita Decker-palmer ◽  
Thanh Dao ◽  
Cynthia Salem ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Clinical Outcomes ◽  
Heart Association ◽  
P Value ◽  
Regression Analyses ◽  
Inpatient Mortality ◽  
Care Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: The American Heart Association (AHA) recently raised the bar on timely treatment of acute ischemic stroke (AIS) with intravenous (IV) alteplase, by recommending door-to-needle times of 30 minutes or less for 50% or more of the AIS patients. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times on efficiency and quality of care, and clinical outcomes. Methods: Our study examined 762 AIS patients treated with IV alteplase in a large academic health system from 2015-2018, and compared their outcomes after treatment within 30, 45 and 60 minutes of arrival. The outcomes compared were: 1) Efficiency of care outcome - Length of stay (LOS); 2) Quality of care outcomes - Inpatient mortality and Disability at discharge; 3) Clinical outcomes - Discharge and 90-day modified Rankin Scale (mRS), and Post-alteplase (24 hr) NIH Stroke Scale (NIHSS). Adjusted logistic and linear regression analyses were used, after controlling for baseline patient socio-demographic and clinical characteristics. Results: Based on the adjusted regression analyses (Table 1), being treated within 30 minutes of arrival reduced the average LOS by 1.3 days (p-value: 0.02), but did not affect the quality of care outcomes. Similarly, being treated within 45 minutes of arrival reduced LOS by 0.9 days (p-value: 0.04). Being treated within 60 minutes of arrival did not affect LOS, but reduced the odds of inpatient mortality by 68% (p-value: 0.00), and disability at discharge by 29% (p-value: 0.08). Being treated within 30 minutes of arrival was associated with better mRS and NIHSS scores as compared with being treated within 45 or 60 minutes. Conclusion: Quicker IV alteplase treatment significantly improved efficiency of care and clinical outcomes. Quality of care outcomes did not improve beyond the 60 minute door-to-needle threshold. This study provides evidence supporting AHA’s new recommendation of 30 minutes or less door-to-needle time.

scholarly journals Regional Changes in Patterns of Stroke Presentation During the COVID-19 Pandemic

Stroke ◽  
2021 ◽  
Vol 52 (4) ◽  
pp. 1398-1406 ◽  
Author(s):  
Mark R. Etherton ◽  
Kori S. Zachrison ◽  
Zhiyu Yan ◽  
Lukas Sveikata ◽  
Martin Bretzner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Stroke Patient ◽  
Regional Analysis ◽  
Clinical Severity ◽  
Stroke Severity ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Patient Presentation

Background and Purpose: Patient care-seeking has likely changed during the coronavirus disease 2019 (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 and telestroke hub, and 24 spoke hospitals in the telestroke network. We included all telestroke consultations from the 24 spokes, and all stroke admissions to the comprehensive stroke center hub from November 1, 2019 through April 30, 2020. We compared rates of presentation, timeliness presentation, and quality of care pre- versus post-March 1, 2020. We examined trends in patient demographics, stroke severity, timeliness, diagnoses including large vessel occlusion, alteplase use, and endovascular thrombectomy among eligible subjects. We compared proportions and bivariate comparisons to examine for changes pre- versus post-March 1, 2020 and used linear regression to examine trends over time. Results: Among 1248 patient presentations (844 telestroke consultations, 404 comprehensive stroke center admissions), telestroke consultations and ischemic stroke patient admissions 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 and thrombectomy at our comprehensive stroke center. Time metrics for patient presentation and care delivery were unchanged; however, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic. 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.

scholarly journals Effect of a primary care based epilepsy specialist nurse service on quality of care from the patients’ perspective: results at two-years follow-up

Seizure ◽  
1999 ◽  
Vol 8 (5) ◽  
pp. 291-296 ◽  
Author(s):  
Nicola Mills ◽  
Max O. Bachmann ◽  
Rona Campbell ◽  
Iain Hine ◽  
Mervyn McGowan
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Specialist Nurse ◽  
Patients Perspective

scholarly journals Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care

2007 ◽  
Vol 21 (11) ◽  
pp. 997-1006 ◽  
Author(s):  
J.H.A. Bloemen-Vrencken ◽  
L.P. de Witte ◽  
M.W.M. Post ◽  
C. Pons ◽  
F.W.A. van Asbeck ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Quality Of Care ◽  
Health Problems ◽  
Follow Up Care ◽  
Care Models ◽  
Injured Patients ◽  
Spinal Cord Injured

Abstract TP317: Utility and Cost of Inpatient Thrombophilia Testing in Ischemic Stroke Patients Aged 18-60

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Effrosyni Apostolidou ◽  
Priya Khatri ◽  
Eric Thomas ◽  
Sean Savitz ◽  
Alicia Zha
Keyword(s):  
Ischemic Stroke ◽  
Cryptogenic Stroke ◽  
Inpatient Setting ◽  
Initial Hospital ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year ◽  
Care Costs ◽  
Fvl Mutation

Introduction: Patients (pts) <60 years with ischemic stroke (IS) are commonly tested for thrombophilias (TP) due to the perception that there could be underlying hypercoagulable states. However, inherited TPs are largely not a risk factor for IS; and testing for acquired TPs in an acute inpatient setting may yield erroneous results that increase health care costs. We reviewed the frequency and cost of TP testing at our institution as part of a plan-do-study act cycle for improving the utilization of inpatient TP testing in young pts after IS. Methods: We performed a retrospective review of 18-60 year old pts admitted for IS to our comprehensive stroke center between 11/2016 and 7/2018. Pts discharged with a stroke etiology not attributed to large vessel (LV), small vessel (SV), or cardioembolic (CE) origin and the initial hospital TP testing monitored. Pts seen subsequently in clinic or later admissions in our system were monitored. Results: Of 1,162 pts, 104 without diagnosed LV/SV/CE etiologies were identified. At least one TP test was performed in 82 (79%) pts (Table 1). In 70 pts testing was done in the initial 24 hrs of hospitalization. One test abnormality was seen in 42 (51%) pts but anticoagulation was initiated in only one 1 patient at discharge. Forty-seven (45%) pts were followed in our outpatient clinic, with a mean follow up of 5 (0.2 – 24) months. TP was confirmed in 3 pts in clinic – two with heterozygous FVL mutation and one with known homozygous FVL mutation. The total charges of the initial inpatient testing is estimated to be as high as $222,150 for 82 patients. Conclusion: Frequent inpatient TP testing in young pts with cryptogenic stroke does not change management and can be costly to the hospital. Based on these results, we created a practice guideline to improve utilization of TP testing starting January 2019. A one year analysis of the effectiveness, safety, and cost for these changes is ongoing.

Parental satisfaction with quality of care in neonatal follow-up programs

2011 ◽  
Vol 17 (6) ◽  
pp. 222-232 ◽  
Author(s):  
Sabrina E. Wong ◽  
Michelle L. Butt ◽  
Amanda Symington ◽  
Janet Pinelli
Keyword(s):  
Quality Of Care ◽  
Parental Satisfaction

scholarly journals Influence of gender norms in relation to child’s quality of care: follow-up of families of children with SCD identified through NBS in Tanzania

2020 ◽  
Author(s):  
Daima Bukini ◽  
Columba Mbekenga ◽  
Siana Nkya ◽  
Leonard Malasa ◽  
Sheryl McCurdy ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Gender Norms
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