Abstract WP342: Linking the Coverdell Clinical Stroke Program Inpatient Registry to Commercial Claims Data to Assess Post-Discharge Medication Adherence

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elisabetta Patorno ◽  
Sebastian Schneeweiss ◽  
Ajinkya Pawar ◽  
Helen Mogun ◽  
Lee Schwamm
Keyword(s):  
Medication Adherence ◽  
Real World ◽  
Large Scale ◽  
Claims Data ◽  
Stroke Severity ◽  
Post Discharge ◽  
Stroke Registry ◽  
Discharge Medication ◽  
Large Populations

Background: Non-interventional large-scale research on patients with stroke requires the use of data sources ensuring access to large populations with clinically detailed and longitudinally available real-world healthcare information. We linked the Paul Coverdell National Acute Stroke Program registry (PCNASP) to commercial longitudinal claims data to assess long-term medication adherence post discharge. Methods: All ischemic stroke (IS) admissions in PCNASP between 2008-2015 were considered for linkage to longitudinal patient claims records from a commercial health insurer using a probabilistic algorithm. We assessed the linkage quality via the percentage of unique records among the linked subset, evaluated the representativeness of the linked population via standardized differences (SD), and described medical history, stroke severity and disability, and patterns of medication use before and after the stroke hospitalization among linked patients. Results: The linkage produced uniqueness equal to 99.1%. Overall, we linked 5,644 out of 104,540 patients with an IS hospitalization in claims data. Linked patients were similar to unlinked except for mean age (69.7 vs 72.5 yr, SD 0.23) and % home discharge (59.8 vs. 52.2, SD 0.14) with mild strokes (median NIHSS 3). Medication information from the PCNASP registry often differed from claims-based out-of-hospital drug utilization patterns, particularly after discharge, with prescriptions at discharge largely overestimating the real-world use of medications as measured by filled prescriptions. (Table) Conclusions: In a large cohort of hospitalized IS patients, high-quality probabilistic linkage between the PCNASP stroke registry and commercial claims data is feasible. Differences between predicted and actual post discharge medication utilization highlight the challenges of assuming long-term medication adherence based on discharge prescriptions. Further research is warranted.

scholarly journals Linking the Paul Coverdell National Acute Stroke Program to commercial claims to establish a framework for real-world longitudinal stroke research

2021 ◽  
pp. svn-2021-001134
Author(s):  
Elisabetta Patorno ◽  
Sebastian Schneeweiss ◽  
Mary G George ◽  
Xin Tong ◽  
Jessica M Franklin ◽  
...  
Keyword(s):  
Longitudinal Data ◽  
Acute Stroke ◽  
Medical History ◽  
Real World ◽  
Large Scale ◽  
Claims Data ◽  
Longitudinal Research ◽  
Medication Use ◽  
Data Availability ◽  
Stroke Severity

BackgroundNon-interventional large-scale research on real-world patients who had a stroke requires the use of multiple data sources ensuring access to longitudinal data from large populations with clinically-detailed information. We sought to establish a framework for longitudinal research on patients hospitalised with stroke by linking information-rich, deidentified inpatient data from the Paul Coverdell National Acute Stroke Program (PCNASP) to commercial and Medicare Advantage longitudinal claims data.MethodsAll stroke admissions in PCNASP between 2008 and 2015 were evaluated for linkage to longitudinal claims from a commercial insurer using an algorithm based on six available common data fields (patient age, gender, admission date, discharge date, discharge diagnosis and state) and a hospital match. We evaluated the linkage quality (via the percentage of unique records in the linked dataset) and the representativeness of the linked population. We also described medical history, stroke severity and patterns of medication use among the PCNASP-claims linked cohort.ResultsThe linkage produced uniqueness equal to 99.1%. We identified 5644 linked and 98 896 unlinked patients who had an ischaemic stroke hospitalisation in claims data. Linked patients were younger than unlinked (69.7 vs 72.5 years), but otherwise similar by medical history, prestroke medication use or lab values. Stroke severity was mild and most patients were discharged home. Prestroke and discharge use of antihypertensive and statins in the PCNASP were greater than their use as measured by filled prescriptions in claims.ConclusionsHigh-quality linkage between the PCNASP and commercial claims data is feasible. This linkage identified differences between reported or recommended versus actual out-of-hospital medication utilisation, highlighting the importance of longitudinal data availability for research aimed to improve the care of patients who had a stroke.

scholarly journals PS2-46: Examining Post-Discharge Medication Adherence and Gender in a Medical Aid Population

2013 ◽  
Vol 11 (3) ◽  
pp. 162-162
Author(s):  
L. Thibodeaux ◽  
R. McIntyre ◽  
A. Hochhalter ◽  
J. Zeber
Keyword(s):  
Medication Adherence ◽  
Post Discharge ◽  
Medical Aid ◽  
Discharge Medication ◽  
And Gender

scholarly journals Improving Post-Discharge Medication Adherence in Patients with CVD: A Pilot Randomized Trial

2014 ◽  
Author(s):  
Alfredo D. Oliveira-Filho ◽  
Donald E. Morisky ◽  
Francisco A. Costa ◽  
Sara T. Pacheco ◽  
Sabrina F. Neves ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Randomized Trial ◽  
Post Discharge ◽  
Discharge Medication

scholarly journals Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions

2018 ◽  
Vol 7 (6) ◽  
pp. 403-412 ◽  
Author(s):  
Ronen R. Leker ◽  
Jose E. Cohen ◽  
David Tanne ◽  
David Orion ◽  
Gregory Telman ◽  
...  
Keyword(s):  
Multivariate Regression Analysis ◽  
Large Vessel ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Systemic Thrombolysis ◽  
Stroke Registry ◽  
Excellent Outcome ◽  
Vessel Patency ◽  
Short And Long Term

Background and Aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization. Patients treated with bridging were compared to those treated with dEVT. Excellent outcome was defined as having a modified Rankin Scale score ≤1 at 90 days following stroke. Results: Out of 392 patients that underwent thrombectomy, 270 (68%) presented within 4 h and were included. Of those, 159 (59%) underwent bridging and 111 (41%) underwent dEVT. Atrial fibrillation and congestive heart failure were more common in the dEVT group (43 vs. 30%, p = 0.04 and 20 vs. 8%, p = 0.009, respectively), but other risk factors, demographics, stroke severity and subtypes as well as baseline vessel patency state and time metrics did not differ. Excellent target vessel recanalization defined as TICI 3 (thrombolysis in cerebral infarction score) was more common in the dEVT group (75 vs. 61%, p = 0.03), but in-hospital mortality, discharge destinations, short- and long-term excellent outcome rates did not differ. On multivariate regression analysis, treatment modality did not significantly modify the chances of excellent outcome at discharge (OR 0.7; 95% CI 0.3–1.5) or at 3 months (OR 0.78 95% CI 0.4–1.4). Conclusions: The chances of attaining excellent functional outcomes are similar in ELVO patients undergoing dEVT or bridging.

scholarly journals Adversarial Feature Disentanglement for Long-Term Person Re-identification

2021 ◽  
Author(s):  
Wanlu Xu ◽  
Hong Liu ◽  
Wei Shi ◽  
Ziling Miao ◽  
Zhisheng Lu ◽  
...  
Keyword(s):  
Real World ◽  
Large Scale ◽  
State Of The Art ◽  
Feeding Strategy ◽  
Feature Space ◽  
Image Space ◽  
Original Image ◽  
Short Term ◽  
Identification Methods

Most existing person re-identification methods are effective in short-term scenarios because of their appearance dependencies. However, these methods may fail in long-term scenarios where people might change their clothes. To this end, we propose an adversarial feature disentanglement network (AFD-Net) which contains intra-class reconstruction and inter-class adversary to disentangle the identity-related and identity-unrelated (clothing) features. For intra-class reconstruction, the person images with the same identity are represented and disentangled into identity and clothing features by two separate encoders, and further reconstructed into original images to reduce intra-class feature variations. For inter-class adversary, the disentangled features across different identities are exchanged and recombined to generate adversarial clothes-changing images for training, which makes the identity and clothing features more independent. Especially, to supervise these new generated clothes-changing images, a re-feeding strategy is designed to re-disentangle and reconstruct these new images for image-level self-supervision in the original image space and feature-level soft-supervision in the disentangled feature space. Moreover, we collect a challenging Market-Clothes dataset and a real-world PKU-Market-Reid dataset for evaluation. The results on one large-scale short-term dataset (Market-1501) and five long-term datasets (three public and two we proposed) confirm the superiority of our method against other state-of-the-art methods.

Abstract T P356: Functional Outcomes of the Acute Ischemic Stroke Patient Population

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Pam Roberts ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Functional Independence ◽  
Severe Disability ◽  
Stroke Severity ◽  
Post Discharge

Background: Stroke is the leading cause of long-term disability and affects 795,000 in the U.S. each year. This study is conducted to enhance knowledge ofoutcomes after an acute ischemic stroke (AIS).Comprehensive Stroke Certification tasks hospitals with expanding knowledge of functional and quality of life outcomes for AIS patients through the early acute and post-acute phase of recovery and examining the effects of stroke severity, functional impairment,discharge destinations, functional independence, and quality of life post discharge. Researchable question: What are most common setbacks after AIS affetcing functional outcome & readmission? Methods: Looked at AIS patients from 12/2012 -12/ 2013 at Cedars-Sina. Of total of 709 patients 318 were contacted by phone. Measures collected by MedTel Outcomes LLC on all AIS patients one month after discharge. This included the Functional Independence Measure and standardized quality of life and participation measures.The median age was 65 years at the time of the stroke. Results: Most common setbacks were recurrent strokes, pneumonia, falls& heart failure.All caused re-hospitalization after stroke. Discharge destinations 30 days post stroke hospitalization were: home independent 144 (43.3%). No significant disability 49 (14.7%), Slight disability 21 (6.3%) Moderate disability 44 ( 13.2%), moderate to severe disability 43 ( 12.9%) and finally severe disability 31( 9.3%). 83.7 % were home without assistance and 1.3 % were in board and care, 15 patients, (4.7 %) had been readmitted for recurrent stroke, 48 patients had fallen since discharge Conclusions: Over 83.7 % of AIS patients were back living in the community at home with over 60 % having slight disability.The long-term outcomes have implications for late secondary and tertiary prevention and creating a model for predictors of these At follow-up, in terms of physical functioning measures,mostpatients were independent in toileting and self-care activities,half were independent in mobility excluding stairs.Data from this study can be used to understand the functional trajectory of recovery based on severity of stroke, discharge destination and other factors. It is important to understand patients’ characteristics to help prevent readmissions.

scholarly journals Success of 4CMenB in preventing meningococcal disease: evidence from real-world experience

2020 ◽  
Vol 105 (8) ◽  
pp. 784-790 ◽  
Author(s):  
Catherine Isitt ◽  
Catherine A Cosgrove ◽  
Mary Elizabeth Ramsay ◽  
Shamez N Ladhani
Keyword(s):  
Real World ◽  
Meningococcal Disease ◽  
Large Scale ◽  
Safety Data ◽  
Case Fatality ◽  
Sudden Onset ◽  
Rapid Progression ◽  
Real World Data ◽  
The Uk

Meningococcal disease remains one of the most feared infectious diseases worldwide because of its sudden onset, rapid progression and high case fatality rates, while survivors are often left with severe long-term sequelae. Young children have the highest incidence of invasive meningococcal disease (IMD), and nearly all cases in the UK, as in most of Europe and many other industrialised countries, are due to group B meningococci (MenB). The licensure of a broad-coverage, recombinant protein-based MenB vaccine (4CMenB) in 2013 was, therefore, heralded a major breakthrough in the fight against IMD. This vaccine was, however, licensed on immunogenicity and reactogenicity studies only, raising uncertainties about field effectiveness, long-term safety and antibody persistence. In 2015, the UK became the first country to implement 4CMenB into the national infant immunisation schedule and, since then, several countries have followed suit. Seven years after licensure, a wealth of real-world data has emerged to confirm 4CMenB effectiveness, along with large-scale safety data, duration of protection in different age groups, successful strategies to reduce vaccine reactogenicity, impact on carriage in adolescents and the potential for 4CMenB to protect against other meningococcal serogroups and against gonorrhoea. A number of questions, however, remain unanswered, including the investigation and management of vaccine-associated fever in infants, as well as disease severity and assessment of breakthrough cases in immunised children. Increasing use of 4CMenB will provide answers in due course. We now have vaccines against all the major serogroups causing IMD worldwide. Next-generation and combination vaccines against multiple serogroups look very promising.

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