Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke

Bravata, Dawn M.; Myers, Laura J.; Reeves, Mathew J.; Cheng, Eric M.; Baye, Fitsum; Ofner, Susan; Miech, Edward J.; Damush, Teresa M.; Sico, Jason J.; Zillich, Alan J.; Phipps, Michael; Williams, Linda S.; Chaturvedi, Seemant; Johanning, Jason M.; Yu, Zhangsheng; Perkins, Anthony J.; Zhang, Ying; Arling, Greg

doi:10.1001/jamanetworkopen.2019.6716

Cited by 23 publications

(28 citation statements)

References 35 publications

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“…Such comparative studies remain rare, even for developed countries. People with a history of stroke represent the group with the highest stroke risk, and studies have shown that recurrent stroke was not uncommon among stroke patients and could be fatal [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study

Pu¹,

Guo

Yu-Hua-Yeh³

et al. 2020

AIMS Public Health

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Background In many parts of Africa, there is limited information on awareness of symptoms of stroke, risk factors for stroke and willingness for stroke prevention, both in the general population and in people with stroke. Knowledge and preventive efforts for stroke in patients with a history of the illness are rarely investigated. This study aims to investigate awareness of stroke symptoms in stroke patients who were admitted to hospitals within 72 hours of a confirmed stroke event in Burkina Faso. This study also aims to investigate preventive behavior for stroke for the general population. Methods Face-to-face interviews were conducted with the participants. The sample included 110 first-time stroke patients who had been admitted to one of three tertiary teaching hospitals in Burkina Faso within 72 hours and 750 participants from the general population, who were recruited through clustered sampling. Knowledge of stroke warning signs and current and future efforts on stroke prevention were also assessed. Results Only 30.9% of the stroke patients believed that they were at risk before the stroke episode. Obvious warning signs were unfamiliar to both groups. Only 1.3% of the respondents from the general population group knew sudden weakness face arm or leg as a sign of stroke. For all future efforts in stroke prevention, stroke patients demonstrated significantly lower willingness to undertake behavioral changes than the general population. Sixty-six percent and 85% of the stroke patients and the general population, respectively, were willing to take steps to reduce blood pressure. Conclusion Public education on stroke warning signs and strategies to increase willingness to engage in preventive behaviors are urgent in African countries. Strategies to improve public awareness for developing countries such as Burkina Faso should be designed differently from that of developed countries to incorporate local beliefs.

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Section: Introductionmentioning

confidence: 99%

Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study

Pu¹,

Guo

Yu-Hua-Yeh³

et al. 2020

AIMS Public Health

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“…Although a facility may be satisfied with an 88.0% pass rate on a consolidated measure of quality, at the patient-level, only 54.0% of patients at that facility received all of the care for which they were eligible. In a study 30 of patients with TIA and ischemic stroke, without-fail care was associated with 31.2% lower odds of 1-year mortality (adjusted OR, 0.69; 95% CI, 0.55-0.87), providing evidence to support the association between quality and outcome. Health care systems should consider including TIA in their existing stroke quality measurement programs and should consider evaluating progress against all-or-none quality measures.…”

Section: Discussionmentioning

confidence: 93%

Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack

et al. 2020

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“…The primary effectiveness outcome was the “without-fail” rate, defined as the proportion of Veterans with TIA who received all of the processes of care for which they were eligible from among seven processes of care: brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial fibrillation, antithrombotics, and high/moderate potency statins [37]. These seven measures were included in the without-fail rate because they are both guideline-recommended processes of care and they have been associated with improvements in TIA patient outcomes [37]. The without-fail rate is sometimes also referred to as “defect-free” care [38, 39].…”

Section: Methodsmentioning

confidence: 99%

The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods

et al. 2019

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BackgroundTransient ischemic attack (TIA) patients are at high risk of recurrent vascular events; timely management can reduce that risk by 70%. The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) developed, implemented, and evaluated a TIA quality improvement (QI) intervention aligned with Learning Healthcare System principles.MethodsThis stepped-wedge trial developed, implemented and evaluated a provider-facing, multi-component intervention to improve TIA care at six facilities. The unit of analysis was the medical center. The intervention was developed based on benchmarking data, staff interviews, literature, and electronic quality measures and included: performance data, clinical protocols, professional education, electronic health record tools, and QI support. The effectiveness outcome was the without-fail rate: the proportion of patients who receive all processes of care for which they are eligible among seven processes. The implementation outcomes were the number of implementation activities completed and final team organization level. The intervention effects on the without-fail rate were analyzed using generalized mixed-effects models with multilevel hierarchical random effects. Mixed methods were used to assess implementation, user satisfaction, and sustainability.DiscussionPREVENT advanced three aspects of a Learning Healthcare System. Learning from Data: teams examined and interacted with their performance data to explore hypotheses, plan QI activities, and evaluate change over time. Learning from Each Other: Teams participated in monthly virtual collaborative calls. Sharing Best Practices: Teams shared tools and best practices. The approach used to design and implement PREVENT may be generalizable to other clinical conditions where time-sensitive care spans clinical settings and medical disciplines.Trial registrationclinicaltrials.gov: NCT02769338 [May 11, 2016].

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Processes of Care Associated With Risk of Mortality and Recurrent Stroke Among Patients With Transient Ischemic Attack and Nonsevere Ischemic Stroke

Cited by 23 publications

References 35 publications

Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study

Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study

Assessment of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Program for Improving Quality of Care for Transient Ischemic Attack

The protocol-guided rapid evaluation of veterans experiencing new transient neurological symptoms (PREVENT) quality improvement program: rationale and methods

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