scholarly journals 30-Day Mortality and Readmission After Hemorrhagic Stroke Among Medicare Beneficiaries in Joint Commission Primary Stroke Center-Certified and Noncertified Hospitals

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3387-3391 ◽  
Author(s):  
Judith H. Lichtman ◽  
Sara B. Jones ◽  
Erica C. Leifheit-Limson ◽  
Yun Wang ◽  
Larry B. Goldstein
Keyword(s):  
Hemorrhagic Stroke ◽  
Joint Commission ◽  
Medicare Beneficiaries ◽  
Primary Stroke Center ◽  
Stroke Center

Abstract W P296: Establishing a Stroke Protocol Based on the Trauma Model

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Mary Ann Blosky ◽  
E. Andrew Raposo
Keyword(s):  
Program Development ◽  
Medical Center ◽  
Clinical Signs ◽  
The State ◽  
Joint Commission ◽  
High Performing ◽  
Time Of Application ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Trauma Model

Background and Purpose: In the summer of 2012, the state of Pennsylvania adopted legislation mandating EMS providers to deliver all patients with clinical signs of stroke to a certified stroke center for evaluation. In response to this change, development of a new stroke program began at a tertiary medical center located in the northeastern region of the state. The facility was a certified trauma center and also held various other disease specific certifications through the Joint Commission. This project sought to examine the needs of a newly developing primary stroke center within the context of a healthcare organization with numerous other specialized medical and surgical programs. Specifically, the investigators hoped to illustrate the similarities between stroke and other specialized services to demonstrate that many of the requirements of these programs are shared. Method: The site stroke clinical coordinator and system stroke program coordinator kept detailed records of all phases of stroke program development. As resource needs were identified, notation was made indicating whether or not those resources were already available in the hospital. By examining these records, the coordinators were able to identify how many of the resources needed to develop an effective stroke program were already present within the system. Results: Information was collected beginning at the inception of program development in 2012 through the time of application for Joint Commission Primary Stroke Center certification in August of 2013. During these 9 months, many of the needed resources were found to already exist in the facility, with most having been created or added as a result of the hospital’s trauma program development several years earlier. Conclusion: The hospital was able to develop a high performing stroke center with comparative ease due to the preexisting resources from the institution’s trauma program. It is the belief of the stroke team that these results could be easily duplicated in other facilities with trauma services that wish to expand into stroke specialization as well.

Abstract WP455: Memorial Hermann Hospital System Stroke Coordinators: Working as One

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sandi G Shaw ◽  
Isabel Gonzales ◽  
Hari Indupuru ◽  
Nicole Harrison ◽  
Sean Savitz ◽  
...  
Keyword(s):  
Best Practice ◽  
Quality Care ◽  
High Volume ◽  
Work Load ◽  
Joint Commission ◽  
Large Hospital ◽  
Hospital System ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Joint Commission

Background: Many hospital stroke programs fail to meet or maintain the certification requirements of The Joint Commission (TJC) as a Primary Stroke Center (PSC) or Comprehensive Stroke Center (CSC). The most common reason is the absence of a dedicated stroke program coordinator. There are opportunities for improvement to promote stroke coordinator growth and retention. Purpose: We created The Memorial Hermann Hospital System Stroke Coordinator Alliance to combine resources, reduce workload, and support stroke coordinators in order to promote adherence to best practice and maintain TJC stroke certification. Methods: The Memorial Hermann Hospital System Stroke Coordinator Alliance was developed in 2015. It includes 14 nurses who represent 11 acute care hospitals within a large hospital system in Houston (Figure1). Four of the hospitals are CSCs, five are PSCs, and two are not certified. Monthly meetings are conducted to create standardized access to resources, stroke coordinator orientation, education, medical power plans, process improvement, and data development. Coordinator work groups, a central email and shared drive, biweekly data meetings, and a buddy system were created to reduce work load, improve electronic communication, and streamline data review procedures. A partnership was created to onboard new coordinators and to prepare for mock and real time survey visits. In 2018 data abstraction was standardized across hospitals with use of a homegrown database Stroke Program Registry (REGIS). Results: Of the 14 Stroke Coordinators in place during fiscal years 2015 - 2019, retention was 100%. A total of 19 stroke surveys were completed and recognized as successful by The Joint Commission. A total of 17,148 stroke patients were received with PSC measures averaging greater than 95% and CSC measures above 90%. Conclusion: Implementing program development support for stroke coordinators improves retention and quality care in a high volume stroke system.

Abstract WP318: Mortality Among Newly Certified Stroke Centers and Other Hospitals in the U.S.

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shumei Man ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Metastatic Cancer ◽  
Stroke Care ◽  
Prior History ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Primary Stroke Center ◽  
Short Term Mortality ◽  
Stroke Center

Introduction: Primary Stroke Center (PSC) certification was established to improve stroke care. The numbers of PSCs have significantly increased in the past decade. However, it remains unclear whether PSC certification has any impact on stroke mortality. We examined the short term mortality of hospitals that received initial PSC certification between 2009 and 2013 (new PSCs), compared to those received PSC certification before 2009 (existing PSCs) and those never received PSC certification (NSCs). Method: The inclusion criteria was Medicare beneficiaries aged ≥65 years who were hospitalized between January 1, 2009 to December 31, 2013 with a primary discharge diagnosis of ischemic stroke. The patient information were obtained from the Medicare Provider Analysis and Review (MEDPAR) file. The list and characteristics of hospitals were obtained from the American Hospital Association Annual Survey Database. This study included only those general hospitals with emergency departments. All statistical analyses were performed using SAS Version 9.4 software. Results: Among 1165,960 Medicare beneficiaries included in this study, 28.9% were treated at 2640 NSCs, 24.6% were treated at 634 new PSCs, and 46.6% were treated at 785 existing PSCs. Higher percentages of patients at new and existing PSCs had complicated hypertension, myocardial infarction, congestive heart failure, atrial fibrillation, prior history of cerebrovascular disease, any malignancy, metastatic cancer, peripheral artery disease and smoking (p<0.0001). New PSCs had the lowest unadjusted in-hospital all-cause mortality, followed by NSCs and existing PSCs (4.2%, 4.6% and 5% respectively). Both New and existing PSC groups had lower unadjusted 30 day compared to NSCs (12.5%, 13.2% and 13.7%). New PSCs had lower unadjusted and adjusted 30 day mortality than existing PSCs (Hazard Ratio 0.981, 95% Confidence Interval (0.968, 0.993)). Conclusion: The PSCs that were newly certified between 2009 and 2013 had lower unadjusted in-hospital and 30 day mortality after stroke than existing PSCs and NSCs. It is important to further understand whether this difference results from change in patient population or quality of care.

Joint Commission Primary Stroke Center Certification Increases rt-PA Treatment (PD2.004)

Neurology ◽  
2012 ◽  
Vol 78 (Meeting Abstracts 1) ◽  
pp. PD2.004-PD2.004
Author(s):  
M. Mullen ◽  
S. Kasner ◽  
M. Kallan ◽  
D. Kleindorfer ◽  
K. Albright ◽  
...  
Keyword(s):  
Joint Commission ◽  
Primary Stroke Center ◽  
Stroke Center

scholarly journals Stroke Patient Outcomes in US Hospitals Before the Start of the Joint Commission Primary Stroke Center Certification Program

Stroke ◽  
2009 ◽  
Vol 40 (11) ◽  
pp. 3574-3579 ◽  
Author(s):  
Judith H. Lichtman ◽  
Norrina B. Allen ◽  
Yun Wang ◽  
Emi Watanabe ◽  
Sara B. Jones ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Stroke Patient ◽  
Joint Commission ◽  
Certification Program ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
The Joint Commission

scholarly journals Joint Commission Primary Stroke Center Certification Does Not Affect Proband Enrollment: The Siblings With Ischemic Stroke Study

2009 ◽  
Vol 18 (5) ◽  
pp. 363-366 ◽  
Author(s):  
Alexa N. Richie ◽  
Jorge Trejo ◽  
Christian G. Bowers ◽  
Rebecca B. McNeil ◽  
Dale M. Gamble ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Joint Commission ◽  
Stroke Study ◽  
Primary Stroke Center ◽  
Stroke Center

In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience

2021 ◽  
pp. 194187442110070
Author(s):  
Felix Ejike Chukwudelunzu ◽  
Bart M Demaerschalk ◽  
Leonardo Fugoso ◽  
Emeka Amadi ◽  
Donn Dexter ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Statistical Significance ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Community Based ◽  
Chi Square ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center

Background and purpose: In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied. Methods: Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05. Results: There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations. Conclusion: The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

2021 ◽  
pp. 174749302098526
Author(s):  
Juliane Herm ◽  
Ludwig Schlemm ◽  
Eberhard Siebert ◽  
Georg Bohner ◽  
Anna C Alegiani ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

Abstract P636: Social Determinants of Stroke Hospitalization and Mortality in the United States

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Randhir Sagar Yadav ◽  
Durgesh Chaudhary ◽  
Shima Shahjouei ◽  
Jiang Li ◽  
Vida Abedi ◽  
...  
Keyword(s):  
United States ◽  
Income Inequality ◽  
Social Determinants ◽  
Hemorrhagic Stroke ◽  
The United States ◽  
Care Physician ◽  
County Level ◽  
Medicare Beneficiaries ◽  
Level Data ◽  
Control And Prevention

Introduction: Stroke hospitalization and mortality are influenced by various social determinants. This ecological study aimed to determine the associations between social determinants and stroke hospitalization and outcome at county-level in the United States. Methods: County-level data were recorded from the Centers for Disease Control and Prevention as of January 7, 2020. We considered four outcomes: all-age (1) Ischemic and (2) Hemorrhagic stroke Death rates per 100,000 individuals (ID and HD respectively), and (3) Ischemic and (4) Hemorrhagic stroke Hospitalization rate per 1,000 Medicare beneficiaries (IH and HH respectively). Results: Data of 3,225 counties showed IH (12.5 ± 3.4) and ID (22.2 ± 5.1) were more frequent than HH (2.0 ± 0.4) and HD (9.8 ± 2.1). Income inequality as expressed by Gini Index was found to be 44.6% ± 3.6% and unemployment rate was 4.3% ± 1.5%. Only 29.8% of the counties had at least one hospital with neurological services. The uninsured rate was 11.0% ± 4.7% and people living within half a mile of a park was only 18.7% ± 17.6%. Age-adjusted obesity rate was 32.0% ± 4.5%. In regression models, age-adjusted obesity (OR for IH: 1.11; HH: 1.04) and number of hospitals with neurological services (IH: 1.40; HH: 1.50) showed an association with IH and HH. Age-adjusted obesity (ID: 1.16; HD: 1.11), unemployment (ID: 1.21; HD: 1.18) and income inequality (ID: 1.09; HD: 1.11) showed an association with ID and HD. Park access showed inverse associations with all four outcomes. Additionally, population per primary-care physician was associated with HH while number of pharmacy and uninsured rate were associated with ID. All associations and OR had p ≤0.04. Conclusion: Unemployment and income inequality are significantly associated with increased stroke mortality rates.

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