scholarly journals QUALITY OF CARE OF ACUTE STROKE PATIENTS IN LITHUANIA: NATIONAL DATA

2018 ◽  
Author(s):  
Aleksandras Vilionskis
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
National Data ◽  
Stroke Patients

scholarly journals Adherence to Post-Acute Rehabilitation Guidelines Improves Functional Recovery in Stroke

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 333-333
Author(s):  
Pamela W Duncan ◽  
Ronnie D Horner ◽  
Dean M Reker ◽  
VA Medical Ctr ◽  
Kansas City ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke ◽  
Functional Recovery ◽  
Stroke Rehabilitation ◽  
Functional Independence ◽  
Case Mix ◽  
Stroke Patients ◽  
Sf 36 ◽  
Acute Rehabilitation

97 Purpose & Methods: To assess if compliance with post-stroke rehabilitation guidelines improves functional recovery. The design of the study was an inception cohort of stroke patients followed prospectively for 6 months. The setting was eleven Department of Veteran Affairs Medical Centers providing care to stroke patients. The subjects included 288 selected patients with stroke admitted between January 1998 - March 1999. Data were abstracted from medical records and telephone interviews. Primary outcome was the Functional Independence Motor Score (FIM). Secondary outcomes included Instrumental Activities of Daily Living (IADL), SF-36 physical functioning, and the Stroke Impact Scale (SIS). Acute and post-acute rehabilitation composite compliance scores (range 0–100) were derived from an algorithm. All outcomes were adjusted for case mix. Results: Average compliance scores in acute and post acute care settings were 68.2% (+ 14) and 69.5% (+ 14.4), respectively. After case-mix adjustment, level of compliance with post-acute rehabilitation guidelines was significantly associated with FIM motor, IADL, and the SIS physical domain scores. SF-36 physical function scores and mortality were not affected by compliance with post-acute rehabilitation guidelines. Level of compliance with rehabilitation guidelines in acute settings was unrelated to any of the outcome measures. Conclusion: Process of care in post-acute stroke rehabilitation affects 6-month functional recovery. Our findings support the use of guidelines as means of assessing quality of care and improving outcomes. These quality indicators are needed to ensure that quality of care is not comprised with new organizational and funding changes involving post-acute stroke care.

Abstract W P287: Does Comprehensive Stroke Certification Demonstrate a Significant Effect on Volume and Quality of Care?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Laurie Paletz ◽  
Shlee Song ◽  
Nili Steiner ◽  
Betty Robertson ◽  
Nicole Wolber ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Turnaround Time ◽  
Joint Commission ◽  
Stroke Patients ◽  
Number Of Patients ◽  
The Impact

Introduction/Background information: At the onset of acute stroke symptoms, speed, capability, safety and skill are essential-lost minutes can be the difference between full recoveries, poor outcome, or even death. The Joint Commission's Certificate of Distinction for Comprehensive Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. While many hospitals have been surveyed, Cedars Sinai was the 5 th hospital in the nation to receive this certification. Researchable question: Does Comprehensive stroke certification (CSC) demonstrate a significant effect on volume and quality of care? Methods: We assembled a cross-functional, multidisciplinary expert team representing all departments and skill sets involved in treating stroke patients. We carefully screened eligible patients with acute ischemic stroke We assessed the number of patients treated at Cedars-Sinai with IV-T-pa t 6 months before and then 6 months after CSC and the quality of their care including medical treatment and door to needle time. Results: In the 6 months prior to Joint Commissions Stroke Certification we treated 20 of 395acute stroke patients with t-PA with an average CT turnaround time of 31±19minutes and an average Door to needle time (DTNT) of 68±32minutes. In the 6 months since Joint Commission Stroke Certification we have increased the number of acute stroke patients treated by almost double. There were 37 out of 489(P=0.02, Chi Square) patients treated with IV t-PA with an average CT turnaround time of 22±7minutes (p=0.08, t-test, compared to pre-CSC) and an average DTNT of 61± 23minutes (not different than pre-CSC). Conclusion: We conclude that Joint Commission Certification for stroke was associated with an increased rate of treatment with IV rt-PA in acute ischemic stroke patients. We were not able to document an effect on quality of care. Further studies of the impact of CSC certification are warranted.

scholarly journals Treatment with Diazepam in Acute Stroke Prevents Poststroke Seizures: A Substudy of the EGASIS Trial

2021 ◽  
pp. 1-6
Author(s):  
Julia H. van Tuijl ◽  
Elisabeth P.M. van Raak ◽  
Robert J. van Oostenbrugge ◽  
Albert P. Aldenkamp ◽  
Rob P.W. Rouhl
Keyword(s):  
Placebo Group ◽  
Acute Stroke ◽  
Incidence Rate Ratio ◽  
Day Treatment ◽  
Stroke Patients ◽  
Early Administration ◽  
Anterior Circulation ◽  
Double Blind

<b><i>Objective:</i></b> The frequency of seizures after stroke is high, with a severe impact on the quality of life. However, little is known about their prevention. Therefore, we investigated whether early administration of diazepam prevents the development of seizures in acute stroke patients. <b><i>Methods:</i></b> We performed a substudy of the EGASIS trial, a multicenter double-blind, randomized trial in which acute stroke patients were treated with diazepam or placebo for 3 days. Follow-up was after 2 weeks and 3 months. The occurrence of seizures was registered prospectively as one of the prespecified secondary outcomes. <b><i>Results:</i></b> 784 EGASIS patients were eligible for this substudy (389 treated with diazepam [49.6%] and 395 treated with placebo [50.4%]). Seizures were reported in 19 patients (2.4% of the total patient group). Seizures occurred less frequently in patients treated with diazepam (1.5 vs. 3.3% in the placebo group); however, this difference was only statistically significant in patients with a cortical anterior circulation infarction (0.9% in the diazepam group vs. 4.6% in the placebo group, incidence rate ratio 0.20, 95% CI: 0.05–0.78, <i>p</i> = 0.02, NNT = 27). <b><i>Conclusion:</i></b> We found that a 3-day treatment with diazepam after acute cortical anterior circulation stroke prevents the occurrence of seizures in the first 3 months following stroke.

scholarly journals COVID-19 Pandemic and Quality of Care and Outcomes of Acute Stroke Hospitalizations: the Paul Coverdell National Acute Stroke Program

2021 ◽  
Vol 18 ◽  
Author(s):  
Xin Tong ◽  
Sallyann M. Coleman King ◽  
Ganesh Asaithambi ◽  
Erika Odom ◽  
Quanhe Yang ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Acute Stroke

Abstract WP237: Improved Thrombolysis Rates and Quality of Care for Stroke Patients Through a Provincial Emergency Department Quality Improvement Initiative

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Devin R Harris ◽  
Robert Stenstrom ◽  
Eric Grafstein ◽  
Mark Collison ◽  
Grant Innes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Performance Measures ◽  
Large Scale ◽  
Primary Outcome ◽  
Baseline Data ◽  
Quality Improvement Initiative ◽  
Stroke Patients

Background: The care of stroke patients in the emergency department (ED) is time sensitive and complex. We sought to improve quality of care for stroke patients in British Columbia (B.C.), Canada, emergency departments. Objectives: To measure the outcomes of a large-scale quality improvement initiative on thrombolysis rates and other ED performance measures. Methods: This was an evaluation of a large-scale stroke quality improvement initiative, within ED’s in B.C., Canada, in a before-after design. Baseline data was derived from a medical records review study performed between December 1, 2005 to January 31, 2007. Adherence to best practice was determined by measuring selected performance indicators. The quality improvement initiative was a collaboration between multidisciplinary clinical leaders within ED’s throughout B.C. in 2007, with a focus on implementing clinical practice guidelines and pre-printed order sets. The post data was derived through an identical methodology as baseline, from March to December 2008. The primary outcome was the thrombolysis rate; secondary outcomes consisted of other ED stroke performance measures. Results: 48 / 81 (59%) eligible hospitals in B.C. were selected for audit in the baseline data; 1258 TIA and stroke charts were audited. For the post data, 46 / 81 (57%) acute care hospitals were selected: 1199 charts were audited. The primary outcome of the thrombolysis rate was 3.9% (23 / 564) before and 9.3% (63 / 676) after, an absolute difference of 5.4% (95% CI: 2.3% - 7.6%; p=0.0005). Other measures showed changes: administration of aspirin to stroke patients in the ED improved from 23.7% (127 / 535) to 77.1% (553 / 717), difference = 53.4% (95% CI: 48.3% - 58.1%; p=0.0005); and, door to imaging time improved from 2.25 hours (IQR = 3.81 hours) to 1.57 hours (IQR 3.0), difference = 0.68 hours (p=0.03). Differences were found in improvements between large and small institutions, and between health regions. Conclusions: Implementation of a provincial emergency department quality improvement initiative showed significant improvement in thrombolysis rates and adherence to other best practices for stroke patients. The specific factors that influenced improvement need to be further explored.

Telestroke and Teleneurology

2021 ◽  
pp. 95-108
Author(s):  
Hartmut Gross ◽  
Jeffrey A. Switzer
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Stroke Patients ◽  
High Quality ◽  
Optimal Care ◽  
Widespread Application ◽  
Rural Sites ◽  
Physician Liability

Evaluation and treatment of acute stroke is the oldest and most widespread application of telemedicine. Telestroke systems allow provision of the same high quality of care provided at specialized stroke centers to patients at emergency departments without stroke coverage. The early treatment achieved with telestroke leads to better functional outcomes in stroke patients, thereby lowering overall cost of patient care. Telestroke networks facilitate optimal care, decrease hospital and physician liability, educate health care professionals, and keep many patients closer to home. Admissions to, rather than transfers from, rural sites retain hospitalization revenues locally and help keep small, financially struggling hospitals viable.

scholarly journals “Weekend Effect” on 30-Day Readmissions among Stroke Survivors: An Analysis of the National Readmission Database

2019 ◽  
Vol 9 (2) ◽  
pp. 66-71 ◽  
Author(s):  
Bijan J. Khaksari ◽  
Erin R. Kulick ◽  
Mitchell S.V. Elkind ◽  
Amelia K. Boehme
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Survey Design ◽  
Indirect Evidence ◽  
Healthcare Research ◽  
Weekend Effect ◽  
Stroke Patients ◽  
Quality Healthcare ◽  
Logistic Regression Models

Background and Purpose: Previous studies suggested that quality of care may be lower on weekends than during the week. We hypothesized that, among patients hospitalized for an index ischemic stroke, those admitted on weekends would have a higher risk of 30-day readmission than those admitted on weekdays. Methods: We utilized the 2013 Nationwide Readmission Database, which includes data on US inpatient admissions from the Agency for Healthcare Research and Quality Healthcare Utilization Project. The database includes a nationally representative weighted probability sample of inpatient hospitalizations regardless of insurance status. Patients with primary acute ischemic stroke were identified using previously validated ICD-9-CM diagnosis codes. We conducted a weighted analysis using survey design logistic regression models to estimate crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for the association between weekend admission and 30-day readmission in ischemic stroke patients. Results: Among 319,317 patients admitted for ischemic stroke, 12.1% were readmitted within 30 days. Those with 30-day readmissions had an average of 8 chronic conditions, and all cardiovascular-related comorbidities increased the risk of 30-day readmissions. Ischemic stroke patients admitted on weekends had odds of 30-day readmission similar to patients admitted on weekdays (OR 1.02; 95% CI 0.98–1.06). Weekend admission also did not affect readmission at 7 or 60 days. Conclusions: We found no association between weekend admission and 30-day readmissions, providing indirect evidence of homogeneity in the quality of care delivered during week day and weekend admissions.

Abstract WMP92: Quality of Care and Outcomes for Acute Ischemic Stroke Patients Admitted During the International Stroke Conference

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Steven R Messe ◽  
Michael T Mullen ◽  
Marguerrite Cox ◽  
Gregg Fonarow ◽  
Eric E Smith ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Multivariable Analysis ◽  
Stroke Patients ◽  
Time Periods ◽  
Iv Tpa

Introduction: Patients who present to the hospital during off-hours receive sub-optimal care and experience worse outcomes, often attributed to reduced staffing. It is unknown whether stroke patients receive less guideline-adherent care and experience worse outcomes when medical providers attend scientific meetings. The AHA International Stroke Conference (ISC) is the premier US conference for cerebrovascular disease and is well attended by stroke clinicians. Methods: The national Get With The Guidelines - Stroke (GWTG-Stroke) dataset was analyzed from 2009-2015 to identify acute ischemic stroke (AIS) patients admitted during: 1) the week of ISC, and 2) the 2 weeks before and 2 weeks after ISC. We compared adherence to GWTG-Stroke quality measures and outcomes for AIS patients admitted during these two time periods using univariable and multivariable analysis, including both patient and hospital level variables. Results: Overall, 69,738 AIS patients were included, mean age 72, 52% female, and 29% non-white. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non-ISC weeks (1,984 vs 1,997, p= 0.95). Patient and hospital characteristics were also similar between ISC vs. non-ISC time periods. No significant differences were noted in 14 quality of care metrics and 5 clinical outcomes between AIS patients treated during ISC vs. non-ISC weeks (Table). After adjusting for potential confounders, among patients who presented within 2 hours of onset there was no difference in the likelihood of receiving IV tPA within 3 hours (adjusted odds ratio 0.89, 95% confidence interval [CI] 0.77 - 1.03, p=0.13), nor in the likelihood of receiving IV tPA within 60 minutes of arrival (adjusted odds ratio 0.92, 95% CI 0.83 - 1.02, p=0.13). Conclusions: The treatment and outcome of patients who present with AIS to a GWTG-Stroke participating hospital are not degraded during the week of the International Stroke Conference.

scholarly journals Trajectories of Stroke Care in Ontario: Which Path to Best Care?

2017 ◽  
Vol 44 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Ruth E. Hall ◽  
Diana Sondergaard ◽  
Walter P. Wodchis ◽  
Jiming Fang ◽  
Prosanta Mondal ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Best Practices ◽  
Hospital Admissions ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Administrative Databases ◽  
Prevention Measures ◽  
Stroke Patients ◽  
Health Card

AbstractBackground:Few studies have tracked stroke survivors through transitions across the health system and identified the most common trajectories and quality of care received. The objectives of our study were to examine the trajectories that incident stroke patients experience and to quantify the extent to which their care adhered to the best practices for stroke care.Methods:A population-based cohort of first-ever stroke/transient ischemic attack (TIA) patients from the 2012/13 Ontario Stroke Audit was linked to administrative databases using an encrypted health card number to identify dominant trajectories (N=12,362). All trajectories began in the emergency department (ED) and were defined by the transitions that followed immediately after the ED. Quality indicators were calculated to quantify best practice adherence within trajectories.Results:Six trajectories of stroke care were identified with significant variability in patient characteristics and quality of care received. Almost two-thirds (64.5%) required hospital admission. Trajectories that only involved the ED had the lowest rates of brain and carotid artery imaging (91.5 and 44.2%, respectively). Less than 20% of patients in trajectories involving hospital admissions received care on a stroke unit. The trajectory involving inpatient rehabilitation received suboptimal secondary prevention measures.Conclusions:There are six main trajectories stroke patients follow, and adherence to best practices varies by trajectory. Trajectories resulting in patients being transitioned to home care following ED management only are least likely and those including inpatient rehabilitation are most likely to receive stroke best practices. Increased time in facility-based care results in greater access to best practices. Stroke patients receiving only ED care require closer follow-up by stroke specialists.

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