Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Gillum, Leslie A.

doi:10.1161/hs0901.094260

Cited by 63 publications

(43 citation statements)

References 47 publications

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“…It is possible that the lack of significant findings associated with the Brain Attack Coalition items might be because more detailed information is required to understand the particular context and application of these factors within each hospital. 23 Although previous studies have found the Brain Attack Coalition items to be highly correlated and to have limited variability between hospitals, 11,23 we did not find this to be the case. Most of the characteristics were present in Ϸ60% to 80% of hospitals, which probably reflects the fact that the prototypes included a broader range of hospitals.…”

Section: Discussioncontrasting

confidence: 70%

“…There have been several previous reports evaluating the impact of neurologists on the quality and efficiency of stroke care. 23,25,26 A study of stroke outcomes in academic medical centers found that in-hospital mortality was lower in those centers that had a vascular neurologist. 23 A study of Medicare recipients found DVT indicates deep venous thrombosis; GA, Georgia; IV-tPA, intravenous tissue plasminogen activator; MA, Massachusetts; MI, Michigan; OH, Ohio.…”

Section: Discussionmentioning

confidence: 99%

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Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care

Reeves

Gargano

Maier

et al. 2010

Stroke

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Background and Purpose-Quality of care may be influenced by patient and hospital factors. Our goal was to use multilevel modeling to identify patient-level and hospital-level determinants of the quality of acute stroke care in a stroke registry. Methods-During 2001 to 2002, data were collected for 4897 ischemic stroke and TIA admissions at 96 hospitals from 4 prototypes of the Paul Coverdell National Acute Stroke Registry. Duration of data collection varied between prototypes (range, 2-6 months). Compliance with 8 performance measures (recombinant tissue plasminogen activator treatment, antithrombotics Ͻ24 hours, deep venous thrombosis prophylaxis, lipid testing, dysphagia screening, discharge antithrombotics, discharge anticoagulants, smoking cessation) was summarized in a composite opportunity score defined as the proportion of all needed care given. Multilevel linear regression analyses with hospital specified as a random effect were conducted. Results-The average hospital composite score was 0.627. Hospitals accounted for a significant amount of variability (intraclass correlationϭ0.18). Bed size was the only significant hospital-level variable; the mean composite score was 11% lower in small hospitals (Յ145 beds) compared with large hospitals (Ն500 beds). Significant patient-level variables included age, race, ambulatory status documentation, and neurologist involvement. However, these factors explained Ͻ2.0% of the variability in care at the patient level. Conclusions-Multilevel modeling of registry data can help identify the relative importance of hospital-level and patient-level factors. Hospital-level factors accounted for 18% of total variation in the quality of care. Although the majority of variability in care occurred at the patient level, the model was able to explain only a small proportion. (Stroke. 2010;41: 2924-2931.)

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care

Reeves

Gargano

Maier

et al. 2010

Stroke

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“…5 Although the American Stroke Association does not explicitly mandate that a neurologist be the sole provider of care to patients with acute stroke, best practices indicate that VNs should play the leading role in stroke units. [9][10][11] The American Board of Psychiatry and Neurology began certifying VNs in the United States in 2005 as a way to formally recognize those who completed special training and who demonstrate competence in all aspects of vascular neurology care. 12 The background of those VNs is diverse.…”

Section: Best Practices For Stroke Carementioning

confidence: 99%

The Growing Shortage of Vascular Neurologists in The Era of Health Reform

Leira

Kaskie²,

Froehler³

et al. 2013

Stroke

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“…Categories of information analyzed included demographic characteristics, such as age, gender, race, and insurance status, as well as other clinical characteristics such as teaching status of the hospital, length of stay, admission priority, stroke center designation, location of the hospital, and whether or not the patient received tPA. All of these were categorized based on previous, similar studies [7,[10][11]. Age was categorized as follows: less than 60 years, 60-69, 70-79, 80-89, and 90 years or older.…”

Section: Variablesmentioning

confidence: 99%

The Effect of tPA on In-Hospital Mortality in Patients Hospitalized with Ischemic Stroke in Florida from 2008-2012

Shihah

Rushud

Aldaham

2017

IJMS

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Introduction. In the U.S., tissue Plasminogen Activator (tPA) is the only approved thrombolytic drug to re-canalize occluded arteries in patients with acute ischemic stroke (AIS). With timely administration, tPA may improve the patient prognosis. The percentage of AIS patients that receive tPA in the U.S., however, varies from 3.0% to 8.5%. Further, there is scarce information on the impact of tPA and short-term mortality among Floridians hospitalized with AIS. This study investigates factors associated with in-hospital mortality among patients admitted to Florida hospitals with AIS who received tPA compared to those who did not receive the thrombolytic. Methods. This is a secondary analysis of the Florida Stroke Registry for 2008-2012. We assessed the association between tPA administration and in-hospital mortality utilizing logistic regression to estimate unadjusted and adjusted odds ratios. Pearson correlation coefficients were used to diagnose for collinearity. Results. A total of 133,052 ischemic stroke patients (51.9% women, average age 71.7±14.4 years) comprised our study sample. Approximately 5% (6,357) of AIS patients received tPA. After adjusting for potential confounders, AIS patients who received tPA were twice as likely to die than AIS patients not receiving tPA (OR=2.0; 95% CI= 1.8-2.2). AIS patients 90 years or older were five times more likely to die than AIS patient < 60 years (OR=5.0; 95% CI 4.4-5.7). Women were less likely to die compared to men (OR=0.9; 95% CI=0.87-0.99). Factors significantly increasing the likelihood of in-hospital mortality among AIS patients receiving tPA included being admitted to teaching hospitals (OR=1.6, 95% CI=1.5-1.7), lack of health insurance coverage (OR=2.0, 95% CI=1.8-2.3), extended hospitalization length of stay > 6 days (OR=1.2, 95% CI= 1.1-1.2), and not being assigned emergent priority at admission (OR=2.7, 95% CI= 2.5-2.9). Conclusion. Our findings suggest that the likelihood of in-hospital mortality among Floridian patients with AIS is twice as higher among those receiving tPA than those AIS patients not receiving the thrombolytic. Increasing age, being a man and admitted to a teaching hospital, lack of health insurance, extended length of stay, and not receiving emergent priority at admission also increased the likelihood of in-hospital dead for AIS patients after receiving tPA.

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Characteristics of Academic Medical Centers and Ischemic Stroke Outcomes

Cited by 63 publications

References 47 publications

Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care

Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care

The Growing Shortage of Vascular Neurologists in The Era of Health Reform

The Effect of tPA on In-Hospital Mortality in Patients Hospitalized with Ischemic Stroke in Florida from 2008-2012

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