Abstract TP283: Association Between Spanish Language and Emergency Medical Service Use in Ischemic Stroke Patients Treated with IV-tPA

Introduction: Use of emergency medical services (EMS) is associated with decreased door-to-needle time in acute ischemic stroke. While racial and ethnic disparities in EMS use are well documented, the role of patient language in EMS use has been understudied. We sought to characterize EMS use by patient language among IV-tPA treated patients at a single center with a large Spanish-speaking patient population. Methods: We identified all patients who received IV-tPA over five years (7/2011-6/2016) at an academic medical center in New York City. Primary language, EMS use, pre-notification, and patient demographics were recorded from the EMR. We compared baseline characteristics, EMS use, and stroke pre-notification between English and Spanish-speaking patients. Logistic regression was used to measure the association between primary patient language and EMS use, adjusting for potential confounders. Results: Over the study period, 391 patients received IV-tPA; 208 (53%) primarily spoke English and 174 (45%) primarily spoke Spanish. Nine patients (2%) spoke other languages and were excluded. Mean age (66 vs. 69, p=0.09), male sex (43% vs. 33%, p=0.05) and median NIHSS (7 vs. 6, p=0.12) did not differ between English and Spanish-speaking patients. Of the 380 (97%) patients with EMS data, EMS use was higher among Spanish-speaking patients (69% vs. 80%, p<0.01). Pre-notification did not differ by language (63% vs. 61%, p=0.8). In a multivariable model adjusting for age, sex, and initial NIHSS, Spanish speakers remained more likely to use EMS (OR 1.9, 95% CI 1.1-3.2, p=0.02). Conclusion: Among patients treated with IV-tPA at an urban academic medical center, EMS usage was higher in Spanish-speakers compared to English-speakers. Although language is not an exact surrogate for ethnicity, these findings are in contrast to previously published work demonstrating low rates of EMS usage among Hispanics. Future studies should evaluate differences in EMS utilization according to primary language as well as ethnicity.

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INCREASING FREQUENCY OF INTRAVENOUS THROMBOLYSIS UTILIZATION IN ACUTE ISCHEMIC STROKE OVER 18 YEARS OF EXPERIENCE IN AN ACADEMIC MEDICAL CENTER IN CHILE: THE RECCA REGISTRY

10.26226/morressier.58e389aed462b8029238579e ◽

2017 ◽

Author(s):

Pablo Lavados

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Intravenous Thrombolysis ◽

Years Of Experience ◽

Academic Medical

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Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽

10.1161/str.46.suppl_1.tp168 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Josephine F Huang ◽

Jennifer E Fugate ◽

Alejandro A Rabinstein

Keyword(s):

Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Treatment ◽

Good Outcome ◽

Time Period ◽

Academic Medical ◽

Younger Age ◽

Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

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Factors Associated with Delay in Presentation to the Hospital for Young Adults with Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000443242 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 10-14 ◽

Cited By ~ 7

Author(s):

Lester Y. Leung ◽

Louis R. Caplan

Keyword(s):

Young Adults ◽

Ischemic Stroke ◽

Time Window ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Severity ◽

Delayed Presentation ◽

Stroke Subtype ◽

Academic Medical ◽

Presentation Methods

Objectives: Young adults with ischemic stroke may present late to medical care, but the reasons for these delays are unknown. We sought to identify factors that predict delay in presentation. Methods: We performed a retrospective cohort study of adults aged 18-50 admitted to a single academic medical center between 2007 and 2012. Results: Eighty six of 141 (61%) young adults with ischemic stroke presented at the health center more than 4.5 h after stroke onset. Diabetes was associated with delays in presentation (p = 0.033, relative risk (RR) 1.4 (95% CI 1.1-1.8)), whereas systemic cancer was associated with early presentations (p = 0.033, RR 0.26 (95% CI 0.044-1.6)). Individuals who were single were more likely to present late than those who were married or living with a partner (p = 0.0045, RR 1.7 (95% CI 1.3-2.2)). Individuals who were unemployed were more likely to present late than those who were employed or in school (p = 0.020, RR 1.4 (95% CI 1.1-1.8)). Age (dichotomized as 18-35 and 36-50), race, home medications, other medical conditions (including common stroke mimics in young adults), and stroke subtype were not determinants of delay in presentation, although there was a trend toward delayed presentations in women (p = 0.076) and with low stroke severity (dichotomized as National Institutes of Health Stroke Scale (NIHSS) ≤5 and NIHSS >5, p = 0.061). Conclusions: A majority of young adults with ischemic stroke presented outside the time window for intravenous fibrinolysis. Diabetes, single status, and unemployed status were associated with delayed presentation.

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Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

International Journal of Breast Cancer ◽

10.1155/2015/835074 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 7

Author(s):

Divya A. Parikh ◽

Rani Chudasama ◽

Ankit Agarwal ◽

Alexandar Rand ◽

Muhammad M. Qureshi ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Medical Center ◽

Academic Medical Center ◽

Safety Net ◽

Primary Language ◽

Breast Cancer Patients ◽

Patient Demographics ◽

Academic Medical ◽

Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

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Increasing frequency of intravenous thrombolysis use in acute ischemic stroke over 17years of experience in a single academic medical center

Journal of the Neurological Sciences ◽

10.1016/j.jns.2015.08.1474 ◽

2015 ◽

Vol 357 ◽

pp. e419

Author(s):

M.P. Vicuña ◽

S. González ◽

V. Olavarría ◽

A. Brunser ◽

A. Hoppe ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Intravenous Thrombolysis ◽

Academic Medical

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Spanish-Speaking Parents’ Experiences Accessing Academic Medical Center Care: Barriers, Facilitators and Technology Use

Academic Pediatrics ◽

10.1016/j.acap.2020.10.008 ◽

2020 ◽

Author(s):

Kori B. Flower ◽

Samuel Wurzelmann ◽

Christine Tucker ◽

Claudia Rojas ◽

Maria E. Díaz-González de Ferris ◽

...

Keyword(s):

Technology Use ◽

Medical Center ◽

Academic Medical Center ◽

Spanish Speaking ◽

Academic Medical ◽

Center Care ◽

Parents Experiences

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Impact of Physician Assistants on the Outcomes of Patients With Acute Myelogenous Leukemia Receiving Chemotherapy in an Academic Medical Center

Journal of Oncology Practice ◽

10.1200/jop.2012.000841 ◽

2013 ◽

Vol 9 (5) ◽

pp. e228-e233 ◽

Cited By ~ 9

Author(s):

Brett E. Glotzbecker ◽

Deborah S. Yolin-Raley ◽

Daniel J. DeAngelo ◽

Richard M. Stone ◽

Robert J. Soiffer ◽

...

Keyword(s):

Service Use ◽

Medical Center ◽

Academic Medical Center ◽

Physician Assistants ◽

Myelogenous Leukemia ◽

Health Service Use ◽

Health Care Outcomes ◽

Academic Medical ◽

Acute Myelogenous ◽

Care Outcomes

The authors' findings suggest that the physician assistant service is associated with increased operational efficiency and decreased health service use without compromising health care outcomes.

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E-128 five-year endovascular acute ischemic stroke intervention experience at a rural academic medical center

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011917.202 ◽

2015 ◽

Vol 7 (Suppl 1) ◽

pp. A99.2-A100

Author(s):

E Akture ◽

C O'Neill ◽

M Gorman ◽

C Commichau ◽

G Linnell ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical

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Abstract WP441: Clinical Documentation Improvement Quality Project to Improve Risk Adjusted Mortality in Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp441 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Randheer S Yadav ◽

Sushil Lakhani ◽

Cassanda Forrest ◽

Bryan Gough ◽

Archana Hinduja ◽

...

Keyword(s):

Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Interdisciplinary Approach ◽

Clinical Documentation ◽

Risk Modeling ◽

Model Group ◽

Stroke Population ◽

Academic Medical ◽

Expected Mortality

Introduction: Vizient clinical database-resource manager (CDB/RM) is an alliance of Academic Medical Centers and their affiliated hospital that collects data to enhance patient care by aligning cost, quality and market performance. The observed-to-expected mortality (O/E) is a risk-adjusted measure of a hospital’s mortality and is based upon documentation of specific variables associated with mortality. Methods: Our comprehensive stroke program participates in Vizient CDB/RM. We defined observed mortality as the rate of patient deaths in the hospital each month. Expected mortality is calculated as the sum of all individually calculated risks with conditions that affect severity, for discharges each month. The O/E ratio is calculated by dividing observed mortality by the expected mortality. An O/E ratio score higher than 1.0 means the hospital’s mortality is higher than expected. Results: We identified the most common discharge diagnosis-related group (DRG) codes for ischemic stroke used by our neurovascular service in 2018. We used the Academic Medical Center Hospital: Risk Modeling Summary for 2016 to determine the model group that was relevant for our population. We chose Model group 23 as the highest yield, as that model covers nearly half our volume based upon our frequently used DRG codes. The team used a shared mortality risk factor standard template to improve documentation practices. The Quality Intervention (QI) plan was implemented July 22, 2019 using an interdisciplinary approach. Clinical teams were educated on specific documentation of variables associated with in-hospital mortality. Vizient CDB/RM data on stroke mortality will be reviewed in September 2019 to determine the effect of the QI on mortality O/E ratio for our ischemic stroke population. Conclusions: Our comprehensive stroke program implemented a clinical documentation improvement QI plan to improve Vizient CDB/RM Risk Adjusted Mortality for our ischemic stroke population. We expect that improving appropriate documentation will assist coding specialist to capture the severity of cases, which should improve the mortality O/E ratio.

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