Abstract WP395: Improving Data Quality for Stroke Performance Measures: A Comprehnsive and Systematic Approach to Inter Rater Reliability in Ohio

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Alice Liskay ◽  
Keyword(s):  
Training Program ◽  
Technical Assistance ◽  
Systems Of Care ◽  
Performance Measure ◽  
Easy Access ◽  
Rater Reliability ◽  
Mortality And Morbidity ◽  
Stroke Systems Of Care ◽  
Data Elements ◽  
Individual Hospital

Background: Ohio has been funded from the Centers for Disease Control and Prevention for the Paul Coverdell National Acute Stroke Prevention Program for over ten years. This data driven program focuses on reducing stroke mortality and morbidity with emphasis on stroke systems of care throughout the continuum. Inter rater reliability is required to confirm reliability and inform quality initiatives. The objective of this study is to determine the annual inter-rater reliability, utilizing Item Specific Percent Agreement (ISPA),after comprehensive abstractor training, in 45 Ohio Coverdell hospitals. Methods: We developed a comprehensive abstraction training program which included: in-person, all-day training for abstractors and reabstractors; reference binders; Question and Answer webinars; abstraction updates at statewide tri-annual Coverdell meetings and easy access, prompt, technical assistance communications for specific questions. Results are shared with individual hospital identifying specific areas for improvement. We examined 395 randomly selected charts from 45 hospitals to determine the overall state and individual hospital ISPA during 2014 to 2015. Up to 67 national stroke performance measure and Coverdell data elements were reviewed for agreement according to eligibility. Charts were abstracted and reabstracted by hospitals using Get With the Guidelines®-Stroke and securely transmitted for analysis. The number of charts provided by hospitals was determined by the previous year’s stroke volume. The statistical package “Rstudio” was used for analysis. Results: A total of 13,528 elements were reviewed. The overall state ISPA was 94.9%, compared to 94% during 2013 to 2014. Hospital agreement scores ranged from 78.2% to 99.6%, compared to the previous 83.1% to 99% in the previous year. Conclusion: The comprehensive abstraction training program developed by Ohio Coverdell has resulted in excellent inter rater reliability scores. ISPA is a feasible method of performing inter-rater reliability.

Abstract WP378: Improving Data Quality for Stroke Performance Measures: a Comprehensive and Systematic Approach to Inter Rater Reliability in Ohio

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Alice Liskay ◽  
Irene Katzan ◽  
Keyword(s):  
Training Program ◽  
Technical Assistance ◽  
Systems Of Care ◽  
Performance Measure ◽  
Easy Access ◽  
Rater Reliability ◽  
Mortality And Morbidity ◽  
Stroke Systems Of Care ◽  
Data Elements ◽  
Individual Hospital

Background: Ohio has been funded from the Centers for Disease Control and Prevention for the Paul Coverdell National Acute Stroke Prevention Program for over ten years. This data driven program focuses on reducing stroke mortality and morbidity with emphasis on stroke systems of care throughout the continuum. Inter rater reliability is required to confirm reliability and inform quality initiatives. The objective of this study is to determine the annual inter-rater reliability, utilizing Item Specific Percent Agreement (ISPA),after comprehensive abstractor training, in 45 Ohio Coverdell hospitals. Methods: We developed a comprehensive abstraction training program which included: in-person, all-day training for abstractors and reabstractors; reference binders; Question and Answer webinars; abstraction updates at statewide tri-annual Coverdell meetings and easy access, prompt, technical assistance communications for specific questions. Results are shared with individual hospital identifying specific areas for improvement. We examined 395 randomly selected charts from 45 hospitals to determine the overall state and individual hospital ISPA during 2014 to 2015. Up to 67 national stroke performance measure and Coverdell data elements were reviewed for agreement according to eligibility. Charts were abstracted and reabstracted by hospitals using Get With the Guidelines®-Stroke and securely transmitted for analysis. The number of charts provided by hospitals was determined by the previous year’s stroke volume. The statistical package “Rstudio” was used for analysis. Results: A total of 13,528 elements were reviewed. The overall state ISPA was 94.9%, compared to 94% during 2013 to 2014. Hospital agreement scores ranged from 78.2% to 99.6%, compared to the previous 83.1% to 99% in the previous year. Conclusion: The comprehensive abstraction training program developed by Ohio Coverdell has resulted in excellent inter rater reliability scores. ISPA is a feasible method of performing inter-rater reliability.

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 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.

Stroke Systems of Care

2016 ◽  
pp. 185-188
Author(s):  
Hardik P. Amin ◽  
Joseph L. Schindler
Keyword(s):  
Systems Of Care ◽  
Stroke Systems Of Care

Abstract P278: Improving Stroke Systems of Care in Nebraska

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Marco A Gonzalez Castellon ◽  
James A BOBENHOUSE ◽  
David Franco ◽  
Beth L Malina ◽  
Mindy Cook ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Rural Areas ◽  
Systems Of Care ◽  
Stroke Care ◽  
The United States ◽  
Advisory Council ◽  
Management Tool ◽  
Acute Stroke Care ◽  
Stroke Systems Of Care ◽  
Get With The Guidelines

Introduction: Stroke is a leading cause of disability in the United States. Disparities in stroke care between metropolitan and rural areas have long been recognized. Access to high-level timely stroke expertise improves outcomes, but in rural areas this is limited by sparse availability of stroke specialists. Since 2006, the Nebraska Stroke Advisory Council, a statewide coalition of stroke experts and stakeholders, began implementing strategies to improve stroke care. In 2016, the Nebraska legislature approved Bill 722, mandating the development of stroke systems of care. In 2018, the AHA and the Helmsley Charitable Trust launched Mission: Lifeline Stroke, a coordinated 3-year program to enhance stroke systems of care in Nebraska. Purpose: To assess advances in acute stroke care in Nebraska after implementing a statewide stroke system of care focused on rural areas. Methods: The Council joined with AHA to expand public and professional stroke education offerings including workshops, conferences, and EMS trainings. They developed state specific treatment guidelines and created educational reinforcement materials. From 2016 to 2019 Get With The Guidelines® (GWTG) was used for stroke data collection and quality improvement in Nebraska. GWTG participating hospitals expanded from 7 to 40 sites (21 critical access). Results: The number of stroke and Transient Ischemic Attack cases reported more than doubled from 2016 to 2019 (1848 to 3987 cases). The door to CT initiated in < 25 minutes improved by 13%. IV alteplase therapy gains included: utilization increased from 8.7% to 11.3%; median door to drug time reduced from 54 to 42 minutes; and door to drug within 60 minutes of arrival increased from 67% to 80.4%.The number of alteplase monitored patients doubled and mechanical thrombectomy cases increased from 77 in 2017 to 138 in 2019. Conclusion: Implementation of strategies in Nebraska, with an emphasis on rural critical access hospitals, led to significant improvements in acute stroke care. This work represents the authors’ independent analysis of local or multicenter data gathered using the AHA Get With The Guidelines® Patient Management Tool but is not an analysis of the national GWTG dataset and does not represent findings from the AHA GWTG National Program

Abstract 145: Transferred Ischemic Stroke Patients Have Worse Outcomes After Endovascular Therapy

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Malik M Adil ◽  
Shyam Prabhakaran
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Systems Of Care ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Transferred Patients ◽  
Stroke Systems Of Care

Background and Objective: Ischemic stroke (IS) patients may require inter-facility transfer for higher level of care. Endovascular treatment is the main indication for transfer. We aimed to compare patient characteristics and clinical outcomes amongst transferred vs. non-transferred IS patients who undergo endovascular therapy. Methods: Patients admitted to US hospitals between 2008 and 2011 with a primary discharge diagnosis of IS were identified by ICD-9 codes (433, 434, 436 and 437.1). Mechanical embolectomy (ME) was identified using the ICD-9 procedure code 39.74 or DRG 543 and cerebral angiography (CA) day 0-1 by 88.41. Using logistic regression, we estimated the odds ratio (OR) and 95% confidence intervals (CI) for intracerebral hemorrhage (ICH), in-hospital mortality, and good outcomes (discharge home or inpatient rehabilitation) among transfer vs. non-transfers, adjusting for potential confounders. Results: Of 116,382 patients with IS treated with ME or CA (7.0% of all patients with IS), 10.1% were performed in transferred patients. Atrial fibrillation and hyperlipidemia was significantly higher in IS transfers. In-hospital mortality was higher among IS transfers (9.0% vs. 3.7%; p<0.001) and discharge to home or inpatient rehabilitation was less likely among transferred IS patients (70.2% vs. 80.6%; p<0.001). ICH was higher among IS transfers (4.6% vs. 1.7%; p<0.001). After adjusting for age, gender, race, presence of hypertension, dyslipidemia, atrial fibrillation, renal failure, alcohol abuse, insurance status, and hospital teaching status, transferred patients had higher odds of ICH (OR 2.0, 95% CI 1.5-2.8, p<0.001)] and death (OR 2.0, 95% CI 1.6-2.4, p<0.001) and lower odds of discharge to home/rehabilitation (OR 0.5, 95% CI 0.4-0.7, p<0.001) . Conclusion: Endovascular treatment for acute ischemic stroke may be associated with worse outcomes among inter-hospital transfer patients compared to non-transfers. Organized stroke systems of care may need to consider pre-hospital strategies to increase direct referrals to comprehensive stroke centers and inter-hospital strategies to reduce delays to treatment.

Abstract WP280: A Potential Scoring System to Predict Infarct Progression During Inter Facility Transfer of Patients for Endovascular Thrombectomy Evaluation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sujan Teegala Reddy ◽  
Elliott Friedman ◽  
Tzu-Ching Wu ◽  
Xu Zhang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Systems Of Care ◽  
Youden Index ◽  
Coefficient Estimates ◽  
Anterior Circulation ◽  
Eligibility Criteria ◽  
Vessel Occlusion ◽  
Hub And Spoke ◽  
Endovascular Thrombectomy ◽  
Stroke Systems Of Care ◽  
Current Guidelines

Introduction: Current guidelines recommend CT ASPECTS≥6 as eligibility criteria for endovascular thrombectomy (EVT), a proven therapy for anterior circulation large vessel occlusion (ACLVO). Infarct progression during inter-facility transfer can render many patients ineligible for EVT. We developed a score utilizing clinical and imaging variables to predict infarct progression. Methods: Patients with ACLVO transferred from a referring hospital (RH) to our EVT capable center between August 2015 and December 2018 were reviewed. Significant predictors (p<0.10) of infarct progression, defined as CT ASPECTS of ≥6 at RH to <6 at hub, were identified using a logistic regression model. Regression coefficient estimates were used to score selected variables. The optimal cut-point was selected based on evaluated Youden index. Results: A total of 132 patients were analyzed. Score ranged from 0 to theoretical limit 18 (table 1): CTA collateral score (2/3/4=0, 0/1=3), Clot location (not ICA/M2=0, M2=2, ICA/M1=3), NIHSS (0-14=0, ≥15=5), use of antiplatelet by history (Yes=0, No=3), CT ASPECTS at RH (10=0, 6-9=2). Patients with score of ≥10.0 were more likely to have infarct progression (OR=22.15, 95% CI 4.99 - 98.35, p<0.001). Conclusions: Our score utilizing clinical and imaging variables provides information on which patients with ACLVO may undergo infarct progression during inter-facility transfer. We plan to externally validate our findings in another hub and spoke network. This score may potentially aid decisions to develop stroke systems of care to triage patients with ACLVO within hub and spoke networks.

Abstract 164: Variation in Acute Ischemic Stroke Metrics for Nationally Certified versus Self-Attested Comprehensive Stroke Centers in the Florida Stroke Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Erika T Marulanda-Londono ◽  
Antonio Bustillo ◽  
Charles Sand ◽  
Mark D Landreth ◽  
Carolina Gutierrez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Systems Of Care ◽  
Recent Change ◽  
National Agency ◽  
Healthcare Facilities ◽  
Stroke Registry ◽  
Treatment Measures ◽  
Stroke Systems Of Care ◽  
Hospital Registry

Background: The Florida Stroke Act set criteria for comprehensive stroke centers (CSC). Hospitals could be certified by a national agency (The Joint Commission (TJC), Det Norske Veritas (DNV), Healthcare Facilities Accreditation Program (HFAP)) or could self-attest as fulfilling CSC criteria. This study aimed to evaluate whether nationally certified (NC) and self-attested hospitals (SA) have similar quality of care in acute ischemic stroke (AIS). Methods: The study population included AIS cases from 37 CSCs (74% of FL CSCs) in the FL-Stroke Registry, a multi-hospital registry using Get With the Guidelines-Stroke data from Jan 2013-Dec 2018. Hospital and patient level characteristics and stroke metrics were evaluated using unadjusted and adjusted (age, sex, race and NIH) analyses. Results: 13 NC-CSCs with 32,061 AIS cases and 24 SA-CSCs with 46,363 AIS cases were included. NCs were larger, with younger patients (71 (60-81) vs 72 (61-82)) and more severe strokes (median NIH; 5 vs 4, NIH ≥ 16; 15.4 vs 11.9% p <.0001). Overall IV tPA utilization (15.4% vs 13.9% p <.0001) and EVT treatment (9.8% vs 7.3% p <.0001) were better in NC CSCs. Median door to CT (23 min (11-76) vs 30 (12-75) p <.001) and door to needle time (38 min (27-51) vs 43(30-56) p <.001) were faster in NC CSCs. In adjusted analysis those arriving to NC by 3 hrs were more likely to get tPA in extended 3-4.5-hour window (OR 1.65, 95% CI 1.10, 2.47 p =.01). Conclusion: Among FL-Stroke Registry CSCs, AIS performance and treatment measures are superior in NC CSC when compared to SA CSCs. These findings have crucial implications for stroke systems of care in Florida and supported recent change in legislation regarding CSC center certification.

Abstract 244: Real World Evaluation of Implementing a Mock Cardiac Arrest Program

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brad Trumpower ◽  
Lee A Kamphuis ◽  
Joseph McEvoy ◽  
Pamela J Weber ◽  
Sarah Krein ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Training Program ◽  
Program Implementation ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Response Team ◽  
Study Team ◽  
National Initiative ◽  
Data Elements

Introduction: In 2019, the Veterans Health Administration (VHA) began rolling out a national initiative to create a standardized mock code training program through the Resuscitation Education Initiative (REdI). We partnered with REdI and the local REdI Mock Code Program team at a Midwestern VA medical center to evaluate the launch of this mock cardiac arrest training program using a mixed methods approach. Methods: The REdI mock cardiac arrest program provided training to VA medical center clinical and non-clinical staff using didactic, small group, and hands-on simulation activities over a 2-day site visit in January 2019 where all facets of the resuscitation team were reviewed. Following this training visit at one VA medical center, 10 mock cardiac arrests were conducted between March 2019 and December 2019. One mock cardiac arrest included a hospital-wide activation and nine were conducted on individual units without activation of the cardiac arrest response team. The research team was composed of clinical and methodological experts who observed 8 of the mock cardiac arrests. We used an observation template to record structured data elements and take field notes during the mock code (e.g., how participants made decisions, assigned roles and quality of communication between the participants). At the end of the mock code, facilitators and the study team collected oral and written feedback from the participants. Results: In the 8 mock cardiac arrests observed, we identified 54 participants. Participants overwhelmingly rated the mock cardiac arrests as positive (83.3%, 45/54). Debriefing-feedback after the mock cardiac arrest was identified as the most helpful aspect (42.6%, 23/54). Areas for improving implementation of the mock cardiac arrest training program focused primarily on the need for a better introduction to the exercise. This included understanding the manikin’s functionality (9.3%, 5/54) and the expectation that participants should perform CPR just as they would in an actual cardiac arrest event (7.4%, 4/54). Two critical takeaways frequently cited by participants related to performance during the mock cardiac arrest were a need for better communication (20.4%, 11/54) and defined roles (18.5%, 10/54). Conclusions: Implementation of a mock cardiac arrest program was positively received by participants at a VA medical center. Moreover, participants identified both opportunities for improving resuscitation performance and optimizing learning experiences as part of program implementation.

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