Abstract 45: Global Impact of the Covid-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes: A Society of Vascular and Interventional Neurology Covid-19 International Collaboration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Mohamad AbdalKader ◽  
Muhammad Mustafa Qureshi ◽  
Michael R Frankel ◽  
Diogo Haussen ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Systems Of Care ◽  
Health Care Systems ◽  
Control Period ◽  
International Study ◽  
High Volume ◽  
Geographic Variations ◽  
Global Impact ◽  
Care Systems ◽  
Low Volume

Introduction: The COVID-19 pandemic led to profound changes in both the organization of health care systems and the psychosocial behavior of the population worldwide. The extent to which the COVID-19 outbreak disrupted stroke systems of care merits study from a global lens. Methods: We conducted a retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The study objectives were to measure the global impact of the pandemic on the volumes for mechanical thrombectomy (MT), stroke and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods prior (immediately preceding and one year prior). A secondary objective was to examine whether these changes in volume were impacted by COVID-19 and baseline hospital center stroke volumes. Third, we evaluated the relationships between stroke and COVID-19 diagnoses. Results: There were 26,699 stroke admissions in the 3 months immediately before compared to 21,576 admissions during the pandemic months, representing a 19.2% (95%CI,-19.7 to -18.7) decline. There were 5,191 MT procedures in the 3 months preceding compared to 4,533 procedures during the pandemic, representing a 12.7% (95%CI,-13.6 to -11.8) drop. Significant reductions were also seen in relation to the prior year control period. The decreases were noted across centers with high, intermediate, and low COVID-19 hospitalization burden, and also across high, intermediate, and low volume stroke centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers. There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, ischemic stroke/TIA and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke and MT volumes. Centers with higher COVID-19 inpatient volumes experienced steeper declines.

scholarly journals EXPRESS: Global Impact of the COVID-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes

2021 ◽  
pp. 174749302199165
Author(s):  
Raul Nogueira ◽  
Mohamad Abdalkader ◽  
Muhammed M Qureshi ◽  
MR Frankel ◽  
Ossama Yassin Mansour ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Health Care Systems ◽  
International Study ◽  
High Volume ◽  
Geographic Variations ◽  
Global Impact ◽  
Icd 10 ◽  
Care Systems ◽  
Low Volume ◽  
One Year

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy (MT), stroke, and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods (immediately preceding and one year prior). Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results: The hospitalization volumes for any stroke, ICH, and MT were 26,699, 4,002, and 5,191 in the 3 months immediately before versus 21,576, 3,540, and 4,533 during the first 3 pandemic months, representing declines of 19.2% (95%CI,-19.7 to -18.7), 11.5% (95%CI,-12.6 to -10.6), and 12.7% (95%CI,-13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/MT centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p<0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/MT volumes.

scholarly journals Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Shamir O. Cawich ◽  
Dexter A. W. Thomas ◽  
Chunilal Ramjit ◽  
Roderick Bhagan ◽  
Vijay Naraynsingh
Keyword(s):  
Inferior Vena ◽  
Health Care Systems ◽  
Vena Cava ◽  
High Volume ◽  
Colorectal Metastases ◽  
Liver Resections ◽  
Resource Poor ◽  
Care Systems ◽  
The Caribbean ◽  
Low Volume

Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems.Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment.Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

Abstract P141: Global Impact of Covid-19 Pandemic on Acute Stroke and Mechanical Thrombectomy - An International Survey

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dileep R Yavagal ◽  
Vasu Saini ◽  
Violiza Inoa ◽  
Hannah E Gardener ◽  
Sheila O Martins ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Mechanical Thrombectomy ◽  
High Volume ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Treatment Practices ◽  
Global Impact ◽  
Significant Difference ◽  
The World ◽  
The Impact

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice. Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software. It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 th to May 15 th , 2020. Results: There were 113 responses across 25 countries. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B). This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic. The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferred-intubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS). There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0.6) or if intubation policy was changed in either direction (p=1). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%). Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic.

Regional critical care delivery systems

2016 ◽  
Author(s):  
Theodore J. Iwashyna ◽  
Colin R. Cooke
Keyword(s):  
Critical Care ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Cost Effective ◽  
Design Decisions ◽  
Regional Systems ◽  
Regional System ◽  
Care Systems ◽  
Regionalization Of Care

A regional system of critical care is one in which hospitals are acknowledged to vary in their care of critically-ill patients, and procedures exist to systematically refer patients to a subset of those hospitals. Given scarcity in health care systems, regional systems of care are an attempt to rationalize differentiation among hospitals. There are several examples that suggest regionalization of care can result in cost-effective improvements in patient outcomes. Yet there are also numerous examples of regional systems of care that offer few benefits to patients, or that fail to actually concentrate patients despite the grand plans of their designers. This chapter suggests several key design decisions that can be used to help improve the effectiveness of regional system of care. Addressing all these issues may offer dramatic benefits for patients.

scholarly journals Spatial accessibility of general inpatient care in Germany: an analysis of surgery, internal medicine and neurology

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jan Bauer ◽  
Doris Klingelhöfer ◽  
Werner Maier ◽  
Lars Schwettmann ◽  
David A. Groneberg
Keyword(s):  
Internal Medicine ◽  
Inpatient Care ◽  
Health Care Systems ◽  
National Level ◽  
Spatial Accessibility ◽  
German Population ◽  
Geographic Variations ◽  
North East ◽  
Morbidity Data ◽  
Care Systems

Abstract Improving spatial accessibility to hospitals is a major task for health care systems which can be facilitated using recent methodological improvements of spatial accessibility measures. We used the integrated floating catchment area (iFCA) method to analyze spatial accessibility of general inpatient care (internal medicine, surgery and neurology) on national level in Germany determining an accessibility index (AI) by integrating distances, hospital beds and morbidity data. The analysis of 358 million distances between hospitals and population locations revealed clusters of lower accessibility indices in areas in north east Germany. There was a correlation of urbanity and accessibility up to r = 0.31 (p < 0.001). Furthermore, 10% of the population lived in areas with significant clusters of low spatial accessibility for internal medicine and surgery (neurology: 20%). The analysis revealed the highest accessibility for heart failure (AI = 7.33) and the lowest accessibility for stroke (AI = 0.69). The method applied proofed to reveal important aspects of spatial accessibility i.e. geographic variations that need to be addressed. However, for the majority of the German population, accessibility of general inpatient care was either high or at least not significantly low, which suggests rather adequate allocation of hospital resources for most parts of Germany.

Staff Competence in Dealing with Traditional Approaches

2008 ◽  
Vol 23 (S1) ◽  
pp. s59-s68 ◽  
Author(s):  
M. Kastrup
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Cultural Context ◽  
Systems Of Care ◽  
Health Care Systems ◽  
Value Systems ◽  
Care Systems ◽  
Traditional Approaches

AbstractHealth care and health care systems should be seen and understood in their socio-cultural context. Modern urbanized societies are likely to exhibit health care pluralism, and different therapeutic approaches are available side-by-side. The various models may take their origin in different cultural traditions, but in most societies one type of care is at a given time considered “above” the others. However health care activities in all societies show a degree of interrelation, reflecting societal changes in which normative practices, value systems and structures change over time. In the current Western health systems evidence-based biomedical care is the prevailing system taught to all professionals.The present paper outlines the prevailing health paradigms, and the advantages and shortcomings of the various approaches and their relation to modern care will be discussed. With increased multicultural backgrounds of patients there is a need for mental health professionals to recognize the existence of traditional approaches and be aware of the parallel systems of care. Competent treatment of such patients requires that mental health professionals are aware of this and exhibit a willingness and ability to bridge between the more traditional and the Western approaches to treatment. The delineations and various aspects of the concept cultural competence and its dimensions will be discussed from a clinical perspective.Comparative studies of the various Western and the traditional approaches respectively will be reviewed.

scholarly journals The impact of COVID-19 pandemic on IBD endoscopic procedures in a high-volume IBD Center

2020 ◽  
Vol 08 (07) ◽  
pp. E980-E984
Author(s):  
Loris Riccardo Lopetuso ◽  
Franco Scaldaferri ◽  
Gianluca Ianiro ◽  
Stefano Bibbò ◽  
Carlo Romano Settanni ◽  
...  
Keyword(s):  
Health Care Systems ◽  
High Volume ◽  
Healthcare Personnel ◽  
Experimental Therapy ◽  
Endoscopic Management ◽  
Endoscopic Procedures ◽  
National Health Care ◽  
Care Systems ◽  
High Level ◽  
The Impact

Abstract Background and study aims The COVID-19 pandemic is having a major clinical and also organizational impact on national health care systems, particularly in high-volume hospitals that are utilized for several essential clinical needs. We aimed to analyze the short-term impact of the SARS-CoV-2 pandemic on management of endoscopic procedures in patients with inflammatory bowel disease (IBD). Patients and methods This was an observational prospective study exploring major clinical and organizational changes in endoscopic management at the IBD Center – CEMAD of the Fondazione Policlinico Gemelli IRCCS, Rome, Italy since the beginning of SARS-CoV-2 pandemic. Results Our IBD Unit, with up to 1,500 IBD patients receiving biotechnological or experimental therapy, represents a high-volume Italian and European IBD center. Since the beginning of the outbreak, our hospital has been extremely impacted by care related to COVID-19 cases, with a consequent need to dramatically reorganize management of endoscopic procedures for IBD. Conclusions Outbreak restrictions have significantly impacted the volume of endoscopic activities for IBD. Specific strategies have been designed to guarantee a high level of safety for both patients with IBD and healthcare personnel dedicated to their treatment.

Abstract 205: Reassessing the Impact of Hospital PCI Volume on STEMI Outcomes

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
James R Langabeer ◽  
Jeffrey Helton ◽  
Junghyun Kim ◽  
Raymond Fowler
Keyword(s):  
Patient Outcomes ◽  
Systems Of Care ◽  
Geographic Location ◽  
High Volume ◽  
System Of Care ◽  
Hospital Size ◽  
Low Volume ◽  
And Gender ◽  
Door To Balloon ◽  
The Impact

Background: Guidelines and Class I AHA/ACCF recommendations suggest that high volume percutaneous coronary interventions (PCI) centers produce better patient outcomes than lower-volume centers. Although limited research suggests that volume matters, most of this research is not current, and was not conducted using hospitals from a fully developed regionalized system of care. Objective: To assess the relationship between hospital PCI volumes and two key patient outcomes: door-to-balloon (D2B) and mortality. Methods: We examined 9,674 STEMI patients who underwent primary percutaneous intervention and 18,539 non-STEMI patients. We relied on data from a developed regional system of care in Dallas County, which has been organized for the last five year and represents 33 PCI-capable hospitals. We used data extracted from the National Cardiovascular Data Registry Action Registry from the 2010-2015. Center volume was divided into three groups: low (<200 PCIs/year), intermediate (between 200-400 PCIs/year), and high (>400 PCIs /year) volumes. We analyzed the data using general linear regression model and logistics regressions. We incorporated institutional covariates as controls, including hospital size (number of beds), teaching status, geographic location (suburban, urban), and percent of managed care. Further, we controlled for patient-level differences by incorporating type of transportation (self, EMS), patient age and gender, and patient’s condition on presentation (shock, heart failure). Results: Mortality and door-to-balloon time were examined for each group. Unadjusted mortality rate and door-to-balloon time were significantly higher in low-volume hospitals compared with high-volume hospitals (6.2% versus 4.2%, p<0.001; 187 min. versus 114 min., p<0.005, respectively). Statistically significant association was found between volume of PCIs and D2B for those who underwent ST-elevation myocardial infarction groups. Intermediate- and high-volume centers are more likely to shorten the D2B compared to low-volume centers (OR: 3.08, P<0.04; OR: 1.29, P<0.001). Mortality was no longer significant in the multivariate analysis, adjusting for other covariates. Overall, high volume operators had better outcomes than low volume operators. Conclusions: The higher-volume PCI hospitals have significantly reduced treatment times. This analysis of contemporary PCI suggests that volume persists as a significant influence on outcomes for STEMI, even in amidst growth of sophisticated, regional systems of care.

scholarly journals Medication Use among Veterans across Health Care Systems

2017 ◽  
Vol 26 (01) ◽  
pp. 235-249 ◽  
Author(s):  
Khoa A. Nguyen ◽  
David A. Haggstrom ◽  
Susan Ofner ◽  
Susan M. Perkins ◽  
Dustin D. French ◽  
...  
Keyword(s):  
Health Care ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Systems Of Care ◽  
Health Care Systems ◽  
Medication Use ◽  
Electronic Record ◽  
Department Of Veteran Affairs ◽  
Care Systems ◽  
Medication Dispensing

SummaryIntroduction: Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population Methods: This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing.Results: Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36% higher than those who had only VA data available and 61% higher than those who had only INPC data available.Conclusions: Our data demonstrated that 17.4% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.

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