Disabling stroke in persons already with a disability

Stroke is the second leading cause of death worldwide and a leading cause of adult disability worldwide. More than a third of individuals presenting with strokes are estimated to have a preexisting disability. Despite unprecedented advances in stroke research and clinical practice over the past decade, approaches to acute stroke care for persons with preexisting disability have received scant attention. Current standards of research and clinical practice are influenced by an underexplored range of biases that may hinder acute stroke care for persons with disability. These trends may exacerbate unequal health outcomes by rendering novel stroke therapies inaccessible to many persons with disabilities. Here, we explore the underpinnings and implications of biases involving persons with disability in stroke research and practice. Recent insights from bioethics, disability rights, and health law are explained and critically evaluated in the context of prevailing research and clinical practices. Allowing disability to drive decisions to withhold acute stroke interventions may perpetuate disparate health outcomes and undermine ethically resilient stroke care. Advocacy for inclusion of persons with disability in future stroke trials can improve equity in stroke care delivery.

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Abstract 352: Early Data From an Implementation Science Study Suggests the Need for Identification and Adoption of Best Practices to Improve the Timeliness of Stroke Treatment

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.352 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Lisa M Monk

Keyword(s):

Best Practices ◽

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Early Data ◽

Screening Tools ◽

Stroke Severity ◽

Ct Scanner ◽

Acute Stroke Care ◽

Stroke Treatment

There is a disconnect from discovery of best treatment options and application into clinical practice in a timely manner. The I M plementation of best Pr actices f O r acute stroke care-de v eloping and optimizing regional systems of Stroke Care (IMPROVE Stroke Care) goal is to develop a regional integrated stroke system that identifies, classifies, and treats patients with acute ischemic stroke more rapidly and effectively with reperfusion therapy. These improvements in acute stroke care delivery are expected to result in lower mortality, fewer recurrent strokes, and improved long term functional outcomes. Recent discoveries in stroke care and advancement in technology extends the window for both TPA administration and mechanical thombectomy. The challenge of implementing these latest advances are difficult considering the ability of hospitals to implement the original American Heart Association (AHA) Systems of Stroke Care recommendations. Early data from this project shows that the challenges continue to exist in recommendations that have been in place as early as 2005. EMS is not utilizing pre-hospital stroke screening tools, only 5% of the time, stroke severity tools, only 7% of the time, lytic checklists, 0% of the time, destination decision changed due to severity score, 0% of the time, and pre-notifying emergency rooms, only 63% of the time. Emergency departments door to CT <45 minutes, only 55% of the time, Lytic given in CT scanner, only 35% of the time, Door to lytic therapy< 45 minutes, 77% of the time, Door to Groin puncture, 81% of the time, and Door to TICI Flow 2c/3 flow <90 minutes, 39% of the time. The Systems of Stroke Care have recommendations that will improve time to treatment and outcomes for patients. This project is working to provide tools, guidance, data, and feedback to improve application of these recommendations and identify best practices and solutions to barriers.

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Benchmarks for acute stroke care delivery

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzt069 ◽

2013 ◽

Vol 25 (6) ◽

pp. 710-718 ◽

Cited By ~ 12

Author(s):

R. E. Hall ◽

F. Khan ◽

M. T. Bayley ◽

E. Asllani ◽

P. Lindsay ◽

...

Keyword(s):

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Acute Stroke Care

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Centralising acute stroke care within clinical practice in the Netherlands: lower bounds of the causal impact

BMC Health Services Research ◽

10.1186/s12913-020-4959-3 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Roel D. Freriks ◽

Jochen O. Mierau ◽

Erik Buskens ◽

Elena Pizzo ◽

Gert-Jan Luijckx ◽

...

Keyword(s):

Clinical Practice ◽

The Netherlands ◽

Acute Stroke ◽

Lower Bounds ◽

Stroke Care ◽

Acute Stroke Care ◽

Causal Impact

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Telemedicine Physician Providers: Augmented Acute Stroke Care Delivery in Rural Texas: An Initial Experience

Telemedicine Journal and e-Health ◽

10.1089/tmj.2004.10.s-90 ◽

2004 ◽

Vol 10 (supplement 2) ◽

pp. S-90-S-94

Author(s):

John Y. Choi ◽

Anne W. Wojner ◽

Robert T. Cale ◽

Peter Gergen ◽

Joseph Degioanni ◽

...

Keyword(s):

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Initial Experience ◽

Acute Stroke Care

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Abstract P93: The Effects of Covid-19 on Telestroke Care Delivery

Stroke ◽

10.1161/str.52.suppl_1.p93 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Johanna L Morton ◽

Suraj Didwania ◽

Eric Anderson ◽

Jason Hallock

Keyword(s):

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Study Data ◽

Stroke Severity ◽

Acute Stroke Care ◽

Significant Difference ◽

Presentation Time ◽

Stroke Group ◽

The U.S

Background: Telestroke is increasingly being utilized to deliver acute stroke care to patients without in-person access to stroke expertise. After the U.S. emergence of the COVID-19 pandemic in March of 2020, reports of its effects on acute stroke care surfaced. This review examines the effect of the COVID-19 pandemic on telestroke care delivery in a large telestroke network, spanning 36 states and 340 hospitals throughout the nation. Methods: For this retrospective observational study, data was reported from the internal medical record platform from three separate time periods - a year before the pandemic (March 2019 - May 2019), the three months immediately prior to the pandemic (December 2019 - February 2020), and the height of the COVID-19 pandemic in the U.S. (March 2020 - May 2020). Two groups were studied, those seen in the emergency department (ED) with a suspected stroke diagnosis, and those who received alteplase in the ED. Results: The analysis revealed a decrease in patient volumes in both groups during the pandemic. The presentation time did not significantly vary between any of the stroke or alteplase groups. There was no significant difference in door-to-consult request times in the pandemic vs prior to the pandemic. The door-to-video time was shorter in the pandemic in alteplase patients compared to immediately prior ( P =0.04), but not compared to 2019 ( P =0.35). There was no significant difference in door-to-decision times or door-to-needle times in all of the groups. There was no difference in stroke severity in the alteplase group during the pandemic, but in the stroke group, stroke severity was higher during the pandemic ( P <0.01). Rates of thrombolysis did not decrease during the pandemic. Conclusion: COVID-19 has strained the U.S. emergency medical system and created unique challenges to treating patients with acute ischemic stroke. Likely due to the size and heterogeneity of the patient population, minimal adverse effects on telestroke process metrics were seen in this particular large teleneurology practice during the COVID-19 pandemic. This review highlights the resilience of our nation’s stroke system of care to withstand the stressor of a worldwide pandemic.

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Telemedicine Physician Providers: Augmented Acute Stroke Care Delivery in Rural Texas: An Initial Experience

Telemedicine Journal and e-Health ◽

10.1089/1530562042632010 ◽

2004 ◽

Vol 10 (1) ◽

pp. 90-94 ◽

Cited By ~ 3

Author(s):

John Y. Choi ◽

Anne W. Wojner ◽

Robert T. Cale ◽

Peter Gergen ◽

Joseph Degioanni ◽

...

Keyword(s):

Acute Stroke ◽

Care Delivery ◽

Stroke Care ◽

Initial Experience ◽

Acute Stroke Care

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Description of a novel telemedicine-enabled comprehensive system of care: drip and ship plus drip and keep within a system of stroke care delivery

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16637967 ◽

2016 ◽

Vol 23 (3) ◽

pp. 428-436

Author(s):

Patricia Commiskey ◽

Arash Afshinnik ◽

Elizabeth Cothren ◽

Toby Gropen ◽

Ifeanyi Iwuchukwu ◽

...

Keyword(s):

Acute Stroke ◽

Care Delivery ◽

Medical Center ◽

Stroke Care ◽

Tissue Type ◽

Team Approach ◽

Care Needs ◽

Acute Stroke Care ◽

Time Sensitivity ◽

Comprehensive Stroke Center

United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines “drip and ship” and “drip and keep” models with a comprehensive stroke center primary hub at Ochsner Medical Center in New Orleans, advanced stroke-capable regional hubs, and geographically-aligned, “stroke-ready” spokes. The primary hub provides vascular neurology expertise via telemedicine and monitors care for patients remaining at regional hubs and spokes using a multidisciplinary team approach. By 2014, primary hub telestroke consults grew to ≈1000/year with 16 min average door to consult initiation and 20 min to completion, and 29% of ischemic stroke patients received recombinant tissue-type plasminogen activator (rtPA), increasing 275%. Most patients remained in hospitals close to home, but neurointensive care and interventional procedures were common reasons for primary hub transfer. Given the time sensitivity and expert consultation needed for complex acute stroke care delivery paradigms, telestroke programs are effective for fulfilling unmet care needs. Combining drip and ship and drip and keep management allows more patients to stay “local,” limiting primary hub transfer unless more advanced services are required. Post admission telestroke management at spokes increases personnel efficiency and can positively impact stroke outcomes.

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Adopting evidence-based guidelines for acute stroke care: barriers and enablers for health professionals

British Journal of Neuroscience Nursing ◽

10.12968/bjnn.2020.16.1.8 ◽

2020 ◽

Vol 16 (1) ◽

pp. 8-11

Author(s):

Joanna Harrison ◽

Anne-Marie Timoroksa ◽

Bindu Gregary ◽

James Edward Hill

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Acute Stroke ◽

Health Professionals ◽

Evidence Based Practice ◽

Stroke Care ◽

Evidence Based ◽

Acute Stroke Care ◽

Barriers And Enablers ◽

Evidence Summary

An evidence summary based on the systematic review: Baatiema L, Otim ME, Mnatzaganian G, de-Graft Aikins A, Coombes J, Somerset S. Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review. Implement Sci. 2017;12:74. 10.1186/s13012-017-0599-3 Evidence-based practice is the keystone of clinical practice, policy and management. Despite this, a knowledge-to-practice gap still exists, and it is estimated to take 17 years for evidence to be translated into clinical practice. The reasons for slow translation in acute stroke care are not completely understood.

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