Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention

Abstract

BackgroundStatin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization.Methods and ResultsThis is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an “opt‐in” to “opt‐out” mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time‐series modeling. The EMR intervention increased both overall in‐hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [P diff]=0.02, P=0.016) and discharge to home or rehabilitation facility (P diff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (P diff=0.17, P=0.033) and rate of discharge to home or rehabilitation (P diff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in‐hospital (P diff=−0.14, P=0.026).ConclusionsA simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.

Statin Adherence Is Associated With Reduced Recurrent Stroke Risk in Patients With or Without Atrial Fibrillation

“…15,16,21,22 The cohort presented here had, by comparison, unusually high levels of overall statin adherence; it is possible that the right-shifted distribution of PDC shown in Figure 1A may be because of the integrated nature of the healthcare delivery system from which the data are derived. Given that hospital discharge has been shown to be a critical moment to impact long-term adherence to the secondary stroke prevention strategies, 23 it is possible that our previously reported EMR intervention to increase statin prescription during stroke hospitalization 13 may have also contributed to long-term statin adherence in this cohort.…”

“…12 KPNC members receive clinical care within an integrated system in which all encounters, laboratory studies, radiological studies, and medication prescriptions are documented in a single large inpatient/outpatient electronic medical record (EMR). 13 KPNC members also fill their prescriptions in KPNC pharmacies, providing us with detailed records on prescription fills from pharmacy databases linked to the EMR. For several years before the study period, internal KPNC guidelines have supported the use of statins in all patients with ischemic stroke, starting as early as possible during the initial stroke hospitalization.…”

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System

“… 20 The mNIHSS differs in only minor ways from the original scale and has been extensively validated against the parent scale 21 ; we have previously reported its use in the context of our KPNC data source. 22 …”

The baseline and repeated measurements of DBP to assess in-hospital mortality risk among critically ill patients with acute myocardial infarction: A retrospective cohort study

“…Our results have several potential clinical implications. Because our data were collected from comprehensive electronic medical records [ 28 ] rather than a billing and administrative database, we used rigorously identified covariates and outcomes. Repeated measures of various DBP provide opportunities for us to enhance the understanding of many important clinical aspects of AMI, including patterns of disease progression and the degree of heterogeneity in disease manifestations across patients.…”