Abstract WMP90: Race/Ethnic Disparities in Short and Long Term Mortality Among Medicare Beneficiaries in Florida and Puerto Rico: Data from the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study - the NINDS Stroke Prevention Intervention Research Program

Background: Race/ethnic disparities in acute stroke care may impact stroke outcomes. We compared short- and long-term mortality by race/ethnicity among Medicare beneficiaries in Get With The Guidelines (GWTG) hospitals participating in the NINDS-funded prospective Florida Puerto Rico Collaboration to Reduce Stroke Disparities Registry (GWTG/CReSD), GWTG hospitals not in the Registry (GWTG/non-CReSD), and non-GWTG hospitals not in the Registry (non-GWTG/non-CReSD). Methods: The population included Medicare beneficiaries age 65+ in FL and PR, hospitalized from 2010-2013 with ischemic stroke (ICD-9 433, 434, 436; N=105,205, mean age=80 years, 54% women). We used mixed logistic models adjusted for demographic and clinical characteristics to assess race/ethnic differences in in-hospital, 30-day, and 1-year mortality, stratifying by hospital type (GWTG/CReSD, GWTG/non-CReSD, non-GWTG/non-CReSD). Results: In the 62 GWTG/CReSD hospitals (N=44013, 84% non-Hispanic White (NHW), 9% NH-Black (NHB), 4% FL-Hispanic (FLH), 1% PR-Hispanic (PRH)), NHB had lower 30-day mortality vs NHW (10% vs 12%; OR 0.86, 95% CI 0.77-0.97), but higher 1-year mortality (22% vs 20%; OR 1.13, 95% CI 1.04-1.23); there were no race/ethnic disparities for in-hospital mortality (NHB=6%, NHW=5%, FLH=7%, PRH=12%). However, in 74 GWTG/non-CReSD hospitals (N=46770, 88% NHW, 8% NHB, 2% FLH, 0% PRH), FLH (5%) and NHB (4%) had higher in-hospital mortality vs NHW (3%). For 113 non-GWTG/non-CReSD hospitals (N=14422, 78% NHW, 7% NHB, 5% FLH, 8% PRH), in-hospital mortality was higher for PRH (17%) and NHB (8%) vs NHW (5%). In-hospital and 1-year mortality were lower in CReSD and in GWTG/non-CReSD vs in non-GWTG/non-CReSD hospitals. Conclusions: FL and PR Medicare beneficiaries treated for stroke in GWTG hospitals (both GWTG/CReSD and GWTG/non-CReSD) had lower mortality vs those treated in non-GWTG hospitals; however, there were less race/ethnic disparities in in-hospital mortality for stroke patients treated at GWTG/CReSD hospitals, which are focused on reducing disparities in acute stroke care. Findings underscore the benefits of quality improvement programs, particularly those focusing on race/ethnic disparities.

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Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study

Journal of the American Heart Association ◽

10.1161/jaha.116.004073 ◽

2017 ◽

Vol 6 (2) ◽

Cited By ~ 13

Author(s):

Ralph L. Sacco ◽

Hannah Gardener ◽

Kefeng Wang ◽

Chuanhui Dong ◽

Maria A. Ciliberti‐Vargas ◽

...

Keyword(s):

Puerto Rico ◽

Acute Stroke ◽

Ethnic Disparities ◽

Stroke Care ◽

Acute Stroke Care ◽

Racial Ethnic

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Abstract TP240: Simulation-Based Learning Improves Neurology Resident Training in Acute Stroke Care

Stroke ◽

10.1161/str.44.suppl_1.atp240 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Waimei Tai ◽

J.j. Baumann ◽

Esther Melamed ◽

Nirali Vora ◽

Neil Schwartz

Keyword(s):

Acute Stroke ◽

Training Session ◽

Vital Signs ◽

Stroke Care ◽

Resident Training ◽

Acute Stroke Care ◽

Simulation Based ◽

Overall Evaluation ◽

Simulation Center

Introduction: Acute “stroke codes” are stressful for the new neurology resident who must lead a multi-disciplinary team and quickly integrate information to make high risk time-sensitive decisions. While other disciplines have used simulation technology for years for cardiac arrest codes, neurology has just begun utilizing this resource. Objective: To improve neurology trainees’ execution of a multi-disciplinary acute stroke code using simulation experience Methods: We identified three learning objectives for the simulation experience: assess tissue plasminogen activator (tPA) eligibility, utilize appropriate order sets, and communicate effectively. Scripts for two emergent scenarios were developed: ischemic stroke requiring i.v. tPA and warfarin-associated intracranial hemorrhage requiring coagulopathy reversal. A standardized patient (SP) was trained. Neurology residents in their first week of training were the learners. Six residents attended a four-hour training session in the Simulation Center at Stanford University. Half of the trainees participated in the scenario while the others observed through live video. The SP acted the part in a fully-equipped, mock emergency room. Monitors, controlled remotely, displayed vital signs which changed to reflect interventions performed. Screens also displayed radiologic data. Trainees communicated with the stroke fellow and nursing regarding the plan of care and placed orders through an electronic medical record in training mode. Debriefing occurred after each scenario. Evaluations were completed and collected. Results: Trainees had positive experiences and felt more comfortable with the stroke code after the training. On a 1-5 scale, learners rated quality of teaching (average 4.6); learning from the scenario (4.8); overall organization (4.2); facilities (5); and overall evaluation (4.6). Conclusions: Simulation training offers a valuable opportunity to enhance neurology resident’s comfort in running stroke codes. Additional studies are required to measure long-term retention of acquired skills and training effect on systems and clinical outcomes.

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The effects of telemedicine on racial and ethnic disparities in access to acute stroke care

Journal of Telemedicine and Telecare ◽

10.1177/1357633x15589534 ◽

2015 ◽

Vol 22 (2) ◽

pp. 114-120 ◽

Cited By ~ 19

Author(s):

Michael J Lyerly ◽

Tzu-Ching Wu ◽

Michael T Mullen ◽

Karen C Albright ◽

Catherine Wolff ◽

...

Keyword(s):

Acute Stroke ◽

Ethnic Disparities ◽

Stroke Care ◽

Racial And Ethnic Disparities ◽

Acute Stroke Care

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A Retrospective Cohort Study on the Association between Red Cell Distribution Width and All-Cause Mortality of Patients with Cholecystitis at ICU Admission

Disease Markers ◽

10.1155/2021/9625220 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Yihua Dong ◽

Yu Pan ◽

Wei Zhou ◽

Yanhuo Xia ◽

Jingye Pan

Keyword(s):

Hospital Mortality ◽

Critically Ill ◽

Regression Models ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Prognostic Effect ◽

Short And Long Term ◽

Long Term Mortality

Background. Elevated red cell distribution width (RDW) has been reported to be associated with mortality in some critically ill patient populations. The aim of this article is to investigate the relationship between RDW and in-hospital mortality and short- and long-term mortality of patients with cholecystitis. Method. We conducted a retrospective cohort study in which data from all 702 patients extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database were used. Receiver operating characteristic (ROC) curves were constructed to evaluate the prognostic predictive value of RDW for in-hospital mortality and short- (i.e., 30-day and 90-day) and long-term (i.e., 180-day, 1-year, 3-year, and 5-year) mortality. We converted RDW into a categorical variable according to quintiles as less than or equal to 13.9%, 14.0-14.8%, 14.9-15.8%, and 15.9-17.2% and more than 17.2%. The Kaplan-Meier (K-M) methods and log-rank tests were used to compare survival differences among different groups. The relationships between RDW levels and in-hospital mortality were evaluated by univariate and multivariate binary logistic regression models. Multivariable Cox regression models were built to investigate the association of RDW on the short-term and long-term mortality. Result. After adjusting for potential confounders, RDW was positively associated with in-hospital mortality (OR: 1.187, 95% CI [1.049, 1.343]) and short- (i.e., 30-day: HR: 1.183, 95% CI [1.080, 1.295], 90-day: HR: 1.175, 95% CI [1.089, 1.268]) and long-term (i.e., 1-year: HR:1.162, 95% CI [1.089, 1.240]) mortality in critically ill patients with cholecystitis. Similar results were also shown in the secondary outcomes of 180-day, 3-year, and 5-year mortality. RDW had a significant accurate prognostic effect on different endpoints and could improve the prognostic effect of scoring systems. Conclusion. High level of RDW is associated with an increased risk of in-hospital mortality and short- and long-term mortality in critically ill patients with cholecystitis. RDW can independently predict the prognosis of patients with cholecystitis.

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Abstract 89: Differences in Acute Stroke Care in Primary and Comprehensive Stroke Centers in Florida: An Analysis of the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study- the NINDS Stroke Prevention Intervention Research Program

Stroke ◽

10.1161/str.48.suppl_1.89 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Erika T Marulanda-Londoño ◽

Maria A Ciliberti-Vargas ◽

Kefeng Wang ◽

Negar Asdaghi ◽

Maranatha Ayodele ◽

...

Keyword(s):

Puerto Rico ◽

Ischemic Stroke ◽

Performance Metrics ◽

Ethnic Disparities ◽

Stroke Care ◽

Acute Stroke Care ◽

Delivery Of Care ◽

Primary Stroke Center ◽

Free Care ◽

Stroke Center

Introduction: Primary stroke center (PSC) and comprehensive stroke center (CSC) designation in Florida aims to improve delivery of care and outcomes for stroke patients. In line with the goals of the NINDS funded Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study, we sought to compare ischemic stroke performance metrics by stroke center designation in participating Florida hospitals. Methods: We analyzed 74,623 cases with acute ischemic stroke from 26 CSC and 40 PSC from January 2010-April 2016. We described patient demographics, comorbidities and Get With The Guidelines-Stroke performance metrics of defect free care (compliance with 7 pre-defined performance core measures), door to CT time (DTCT) ≤25 mins and door to needle time (DTN) ≤60 mins. Results: Compared with PSC patients, CSC patients were younger (70 ± 15 vs. 71 ± 14 years, p<.0001), more likely male (51% vs. 50%, p=.0008), more likely Hispanic (17% vs. 10%, p<.0001) and Black (21% vs. 17%, p<.0001), had more severe strokes (NIHSS median 5 (IQR 2-12) vs. 4 (IQR 1-9); NIHSS ≥16, 12% vs. 9%, p <.0001), were more likely to have atrial fibrillation (19% vs. 17%, p<.0001), and were more likely to arrive by EMS (55% vs. 46%, p<.0001). CSC cases were more likely to have faster DTCT (44 vs. 48 mins, p=.0124 ; < 25 mins 33% vs. 31%, p<.0001). More patients in CSC received thrombolysis (12% vs. 9%, p<.0001), with faster DTN (59 vs. 71 min, p <.0001; ≤60 minutes 53% vs. 37%, p <.0001). Patients in CSC had greater rates of defect free care (85% vs. 82.4%, p<.0001). Blacks had longer median DTCT than Whites and Hispanics in both CSC (56 mins Blacks vs. 41 mins Whites and Hispanics) and PSC (60 mins Blacks, 44 mins Whites, 57 mins Hispanics). Blacks in CSC had longer median DTN (63 mins) than Whites (60 mins) and Hispanics (53 mins). Hispanics had longer median DTN (73 mins) in PSC than Blacks (70 mins) and Whites (70 mins). Conclusion: Patients treated in CSC, compared with those treated in PSC, received better defect-free care and had lower DTCT and DTN times. Race-ethnic disparities in performance metrics are still evident in both CSC and PSC. Identification of these disparities is important to design interventions to reduce disparities and improve stroke quality of care for all.

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Abstract P169: Ethnic Disparities In Short- And Long-term Prognosis After A First Cardiovascular Hospitalization

Circulation ◽

10.1161/circ.129.suppl_1.p169 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Louise Van Oeffelen ◽

Charles Agyemang ◽

Carla Koopman ◽

Karien Stronks ◽

Michiel Bots ◽

...

Keyword(s):

Ethnic Minority ◽

Minority Groups ◽

Ethnic Disparities ◽

Ethnic Minority Groups ◽

Readmission Rates ◽

Majority Population ◽

Short And Long Term ◽

Migrant Groups ◽

Long Term Mortality

Introduction: Ethnic disparities in prognosis after a cardiovascular event have been reported. We investigated differences in mortality and readmission after a first hospital admission for total cardiovascular disease (CVD), AMI, CVA, peripheral arterial disease (PAD), and congestive heart failure (CHF) between several ethnic minority groups and the Dutch majority population. Methods: A nationwide prospective cohort of CVD patients hospitalized between 1998 and 2010 was constructed (N=776,574). Differences in short- and long-term mortality and readmission (0-28 days after admission and 28 days-5 years after admission respectively) between first generation ethnic minority groups (henceforth: migrants) and the Dutch majority population were calculated using multivariable Cox proportional hazard models . Results: In particular mortality after AMI and CVA was higher in migrants compared to the Dutch majority population, except for Moroccans. Short- (HR 1.36; 1.07-1.74) and long-term ( HR 1.45; 1.20-1.75) mortality after CVD was the highest in Chinese migrants. Short-term readmission rates were similar between migrants and the Dutch majority population, except after AMI where mainly lower rates were found (HR:0.37-1.26). Long-term readmission rates were also similar to the Dutch majority population, except after CHF where readmission rates were lower (HR varies between 0.67-0.95), and after AMI where readmission rates for AMI were higher (HR varies between 1.24-1.83). Conclusion: Short- and long-term mortality after CVD is higher in migrant groups than in the Dutch majority population, except after CHF. Differences in readmission rates were more similar to the Dutch majority population, with some fluctuations between sub diseases and migrant groups.

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Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients

Journal of Intensive Care Medicine ◽

10.1177/0885066620963875 ◽

2020 ◽

pp. 088506662096387

Author(s):

Mitchell Padkins ◽

Thomas Breen ◽

Nandan Anavekar ◽

Gregory Barsness ◽

Kianoush Kashani ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hospital Mortality ◽

Albumin Level ◽

Post Discharge ◽

Cardiac Intensive Care Unit ◽

Short And Long Term ◽

Cardiac Intensive Care ◽

Long Term Mortality

Purpose: To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients. Methods: We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression. Results: We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. Conclusion: Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality.

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Impacts of admission serum albumin levels on short-term and long-term mortality in hospitalized patients

QJM ◽

10.1093/qjmed/hcz305 ◽

2019 ◽

Vol 113 (6) ◽

pp. 393-398 ◽

Cited By ~ 2

Author(s):

C Thongprayoon ◽

W Cheungpasitporn ◽

A Chewcharat ◽

M A Mao ◽

S Thirunavukkarasu ◽

...

Keyword(s):

Hospital Mortality ◽

Serum Albumin ◽

Hospital Stay ◽

Reference Group ◽

Albumin Level ◽

Hospitalized Patients ◽

Tertiary Referral Hospital ◽

Short And Long Term ◽

Long Term Mortality

Abstract Aim The aim of this study is to assess the association between admission serum albumin and short- and long-term mortality in all hospitalized patients. Design A single-center cohort study. Methods A retrospective cohort of all adult hospitalized patients at a tertiary referral hospital between January 2009 and December 2013 were analysed. Admission serum albumin was stratified into six groups: ≤2.4, 2.5–2.9, 3.0–3.4, 3.5–3.9, 4.0–4.4 and ≥4.5 g/dl. The outcomes of interest were in-hospital mortality, length of hospital stay and 1-year mortality. Serum albumin of 4–4.4 g/dl was selected as a reference group for outcome comparison. Results A total of 14 075 patients were studied. Admission serum albumin of ≥4.5 g/dl had the lowest in-hospital and 1-year mortality with progressively increased in-hospital mortality observed with decreased admission serum albumin. In adjusted analysis, compared with serum albumin of 4.0–4.4 g/dl, serum albumin of ≤2.4, 2.5–2.9, 3.0–3.4 and 3.5–3.9 were significantly associated with increased in-hospital and 1-year mortality. In contrast, serum albumin of ≥4.5 g/dl was significantly associated with lower 1-year mortality but not in-hospital mortality. Admission serum albumin <4.0 g/dl was significantly associated with a prolonged hospital stay, while admission serum albumin of ≥4.5 g/dl was significantly associated with shorter hospital stay, compared with serum albumin of 4.0–4.4 g/dl. Conclusion Low albumin level at admission was progressively associated with increased short- and long-term mortality in all hospitalized patients even when albumin level was considered in normal range.

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Association Between Adherence to Quality Indicators and 7-Day In-Hospital Mortality After Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.120.029968 ◽

2020 ◽

Vol 51 (12) ◽

pp. 3664-3672

Author(s):

Kirsten Haas ◽

Viktoria Rücker ◽

Peter Hermanek ◽

Björn Misselwitz ◽

Klaus Berger ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Stroke ◽

Quality Indicators ◽

Random Effect ◽

Multivariable Analysis ◽

Stroke Care ◽

Evidence Based ◽

Acute Stroke Care

Background and Purpose: Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals. Methods: Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital. Results: Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%–100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8–13.7]; P <0.001). Conclusions: Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.

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Abstract TP236: Geographical Disparity of Acute Stroke Care Capabilities in Japan From a Nationwide Database: J-ASPECT Study

Stroke ◽

10.1161/str.48.suppl_1.tp236 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Koichi Arimura ◽

Kunihiro Nishimura ◽

Akiko Kada ◽

Satoru Kamitani ◽

Kuniaki Ogasawara ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Stroke ◽

Rural Areas ◽

Patient Characteristics ◽

Stroke Care ◽

International Classification Of Diseases ◽

Stroke Severity ◽

Acute Stroke Care ◽

Nationwide Database ◽

Geographical Disparity

Objective: We previously demonstrated comprehensive stroke care (CSC) capabilities of the hospitals affect in-hospital mortality of patients with acute stroke. With the advent of unprecedented aging society, proper implementation of stroke centers requires understanding of geographical disparity of patient characteristics as well as stroke care capabilities. The aim of this study was to elucidate such geographical disparity regarding acute stroke care in Japan using a nationwide database. Materials and methods: We analyzed the data obtained from the Japanese Diagnosis Procedure Combination-based Payment System in 445 institutions between 2010 and 2012. Patients hospitalized emergently for ischemic stroke(IS), non-traumatic intracerebral hemorrhage(ICH) and non-traumatic subarachnoid hemorrhage(SAH) were identified using International Classification of Diseases-10 diagnosis codes. We classified the location of the hospitals into 4 areas, “Metropolitan Employment Area-Central (MEA-C)”, “ Metropolitan Employment Area-Outlying (MEA-O)”, “Micropolitan Employment Area-Central (McEA-C)”, and “ Micropolitan Employment Area-Outlying (McEA-O)”. We investigated patient characteristics, medical backgrounds, interventions and outcomes for each area. Results: Data obtained from a total of 214,910 patients with acute strokes (136,753 IS, 60,379 ICH and 17,778 SAH) were analyzed. As for patient characteristics, elderly patients and those with hypertension were more common in McEA-C and McEA-O, and stroke severity was more severe in McEA-C in all stroke types. As for hospital characteristics, proportion of admission by ambulance and CSC capabilities of the hospitals were smaller in all stroke types. Moreover, emergent interventions such as intravenous rt-PA infusion were performed at a lesser extent and in-hospital mortality was higher in McEA-C and McEA-O, and severe disability with mRS 3-6 was more often noted in McEA-C in all stroke types. Conclusion: We demonstrated geographical disparity of acute stroke care in Japan from a nationwide database. For proper implementation of stroke centers, centralization of acute stroke care capabilities should be considered in the rural areas to improve outcomes of acute stroke.

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