Pessin Award Lecture 2008: Lessons from the Stroke PROTECT program

Ovbiagele, Bruce

doi:10.1016/j.jns.2008.07.014

Cited by 16 publications

(23 citation statements)

References 39 publications

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“…3 Before SPARCL, serum cholesterol management was underused in eligible patients with ischemic stroke and TIA, 5,6 and prior studies of lipid modifier treatment during the hospital encounter were based on regional, not nationwide data. Stroke hospitalization provides a window of opportunity to assure initiation of management 7 (http://stroke.ahajournals.org/cgi/ content/full/35/12/-R17-417899) and starting treatment during the acute stroke hospital encounter promotes drug adherence 8 and enhances clinical outcomes in the postdischarge setting. 9,10 The objective of this study was 1-fold; first, to assess recent nationwide trends in discharge statin treatment among patients with ischemic stroke and to see if such treatment changed in response to the dissemination of SPARCL trial results, and second, to identify correlates of statin treatment among individuals hospitalized with a cerebrovascular event.…”

mentioning

confidence: 99%

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Ovbiagele

Schwamm

Smith

et al. 2010

Stroke

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confidence: 99%

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Ovbiagele

Schwamm

Smith

et al. 2010

Stroke

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“…Nonetheless, systematic in-hospital stroke quality improvement initiatives have been successfully implemented across several different hospital types. 2 The low number of individuals who underwent DSE prevents precise inferences from being made about the frequency of abnormal cardiac perfusion and subsequent cardiac events in a cohort of hospitalized stroke and transient ischemic attack with high FCRS. Lastly, it might have been helpful to recalculate FCRS at 1 year to assess consistency and impact of additional risk reduction strategies on the score.…”

Section: Discussionmentioning

confidence: 99%

“…Stroke hospitalization provides a window of opportunity to assure initiation of CAD risk management. 2 We assessed the feasibility of asymptomatic CAD management in hospitalized patients with stroke.…”

mentioning

confidence: 99%

Optimizing Screening and Management of Asymptomatic Coronary Artery Disease in Patients With Stroke and Patients With Transient Ischemic Attack

Ovbiagele¹,

Liebeskind²,

Kim³

et al. 2009

Stroke

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Background and Purpose-The feasibility of implementing an expert consensus guideline recommending use of a stroke patient's profile to manage undiagnosed coronary artery disease remains unclear. Methods-Following a guideline-based algorithm, we screened consecutive patients with ischemic stroke and patients with transient ischemic attack for asymptomatic coronary artery disease using the Framingham Heart Study Coronary Risk Score (FCRS) cutoff of high risk (Ն20%) for experiencing a hard coronary artery disease event over a 10-year period.

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“…A Cochrane review of in-hospital pathways for stroke found evidence to be inconclusive, 13 however, it is encouraging that subsequent reports have demonstrated benefit. 14,15 Although seemingly logical, evidence of the value of HIT 16 and of the benefit of integrating PROs within clinical care is currently limited. 17 Both these strategies involve complex interventions, making evaluation methodologically challenging.…”

Section: Summary Of the Experience Future Directions And Challengesmentioning

confidence: 99%

Electronic Stroke CarePath

Katzan

Fan

Speck

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Abstract-We describe the development, implementation, and outcomes of the first 2 years of the Electronic Stroke CarePath, an initiative developed for management of ischemic stroke patients in an effort to improve efficiency and quality of care for patients. The CarePath consists of care pathways for ischemic stroke that are integrated within the electronic health record. Patient-reported outcomes are collected using an external software platform. Documentation tools, order sets, and clinical decision support were designed to improve efficiency, optimize process measure adherence, and produce clinical data as a byproduct of care that are available for future analyses. Inpatient mortality and length of stay were compared before and after CarePath implementation in ischemic stroke patients after adjustment for case-mix. Postdischarge functional outcomes of patients with ischemic stroke were compared between the first 3 months of rollout and remainder of the study period. From January 2011 to December 2012, there were 1106 patients with ischemic stroke on the CarePath. There was a decline in inpatient mortality in patients with ischemic stroke, but not in control patients with intracerebral or subarachnoid hemorrhage.Completion rate of patient-reported questionnaires at postdischarge stroke follow-up was 72.9%. There was a trend toward improved functional outcomes at follow-up with CarePath implementation. Implementation of the Electronic Stroke CarePath is feasible and may be associated with a benefit in multiple different outcomes after ischemic stroke. This approach may be an important strategy for optimizing stroke care in the future. Goals and Vision of the ProgramImprovements in efficiency, quality, and coordination of care are essential for healthcare institutions to adapt successfully in an era of decreasing reimbursement. Heart disease and stroke, which are leading causes of morbidity, mortality, and healthcare costs in the United States, are often among the first diseases to be involved in healthcare innovations and policy changes. 1,2 They were among the first to have disease-specific process and outcome measures publically reported by the Center for Medicare and Medicaid services (CMS) and to have society supported quality registries. Regional and national systems of care are more advanced in stroke and myocardial infarction than in most other diseases. Solutions developed to improve delivery of care for patients with heart disease, and stroke can serve as models for the treatment of other conditions.One important strategy to improve the efficiency and quality of healthcare is standardization of care. This is often done by implementing evidence-based protocols that incorporate guidelines into care algorithms. Evidence-based protocols can improve quality by providing guidance on indications for tests or interventions. A related method is the use of care paths, also referred to as critical pathways or care pathways. These are management plans that additionally provide the sequence and timing of actions ...

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Pessin Award Lecture 2008: Lessons from the Stroke PROTECT program

Cited by 16 publications

References 39 publications

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Recent Nationwide Trends in Discharge Statin Treatment of Hospitalized Patients With Stroke

Optimizing Screening and Management of Asymptomatic Coronary Artery Disease in Patients With Stroke and Patients With Transient Ischemic Attack

Electronic Stroke CarePath

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