scholarly journals Cost-Effectiveness of Optimizing Acute Stroke Care Services for Thrombolysis

Stroke ◽  
2014 ◽  
Vol 45 (2) ◽  
pp. 553-562 ◽  
Author(s):  
Maria Cristina Penaloza-Ramos ◽  
James P. Sheppard ◽  
Sue Jowett ◽  
Pelham Barton ◽  
Jonathan Mant ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Care Services

scholarly journals The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

Stroke ◽  
2012 ◽  
Vol 43 (6) ◽  
pp. 1617-1623 ◽  
Author(s):  
Gregory F. Guzauskas ◽  
Denise M. Boudreau ◽  
Kathleen F. Villa ◽  
Steven R. Levine ◽  
David L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
The Cost

Abstract T P351: Stroke Care Team Associations with Acute Stroke Quality Improvement in Veterans Healthcare Administration

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Teresa M Damush ◽  
Zhangsheng Yu ◽  
James Slaven ◽  
Virginia Daggett ◽  
Danielle Sager ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Stroke ◽  
Guideline Adherence ◽  
Stroke Care ◽  
Early Response ◽  
Quality Data ◽  
Late Response ◽  
Acute Stroke Care ◽  
Care Services ◽  
Organizational Constructs

Background and Objective: We conducted standardized semi-structured baseline interviews to understand organizational constructs of stroke teams on a composite, acute stroke quality indicator across 11 VA Medical Centers (VAMCs). Methods: We conducted 104 semi-structured, in person, baseline interviews with clinical providers of acute stroke care services. Respondents were from nursing, emergency medicine, neurology, rehabilitation, inpatient care, medicine and quality management. We audiotaped the interviews, transcribed verbatim, and de-identified the data. Data were qualitatively coded using Nvivo software to tag segments of text into meaningful units based upon our Facilitating Best Practices Framework. Coders met regularly to review and consolidate emergent themes. Additionally a standardized team of chart abstractors collected 10 acute stroke quality indicators from a central location which comprised the composite. The follow up period included 6 (early response) and 12 (late response) months after a stroke collaborative. Results: At baseline, the VAMCs with a higher proportion of its respondents reporting regular monthly communication about stroke were associated with a late response in stroke quality improvement while sites with a lower proportion reporting regular monthly communication were associated with an early response in quality. VAMCs reporting the use of a designated nurse to promote guideline adherence and disease management were associated with an early response in quality. VAMCs reporting tracking their quality data and providing feedback to clinicians were associated with an early and late response in stroke quality improvement compared to those who did not. Finally, sites reporting the timely detection of acute stroke in the Emergency Department as a barrier at baseline were associated with no improvement in stroke quality. Conclusion: Our data suggests that clinical teams that wish to improve their quality may redesign their organization of care as structured to communicate regularly among their team, utilize nurses as designated for guideline adherence, track their quality data and provide feedback to clinicians, and triage presenting strokes in a timely manner. Funded by VA HSRD QUERI SDP #09-105

scholarly journals MO2 The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

2012 ◽  
Vol 15 (4) ◽  
pp. A8
Author(s):  
G.F. Guzauskas ◽  
D.M. Boudreau ◽  
K.F. Villa ◽  
S.R. Levine ◽  
D.L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
The Cost

scholarly journals Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia

2021 ◽  
pp. 1-9
Author(s):  
Anna Ramos-Pachón ◽  
Álvaro García-Tornel ◽  
Mònica Millán ◽  
Marc Ribó ◽  
Sergi Amaro ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Stroke Care ◽  
Care Quality ◽  
Point Of View ◽  
Stroke Severity ◽  
Acute Stroke Care ◽  
Vessel Occlusion ◽  
Prehospital Delays ◽  
The Impact

<b><i>Introduction:</i></b> The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system’s bottlenecks from a territorial point of view. <b><i>Methods:</i></b> Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15–May 2, 2020) and an immediate prepandemic period (January 26–March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. <b><i>Results:</i></b> Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = −0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05–2.4], <i>p</i> 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4–0.9], <i>p</i> 0.015) during the pandemic period. <b><i>Conclusion:</i></b> During the COVID-19 pandemic, Catalonia’s stroke system’s weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system’s analysis is crucial to allocate resources appropriately.

scholarly journals Acute Stroke Care during the COVID-19 Pandemic: Reduction in the Number of Admissions of Elderly Patients and Increase in Prehospital Delays

2021 ◽  
pp. 1-7
Author(s):  
Gabriel Velilla-Alonso ◽  
Andrés García-Pastor ◽  
Ángela Rodríguez-López ◽  
Ana Gómez-Roldós ◽  
Antonio Sánchez-Soblechero ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Stroke ◽  
Time Course ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Group Data ◽  
Radiological Data ◽  
History Of ◽  
Prehospital Delays

Introduction: We analyzed whether the coronavirus disease 2019 (COVID-19) crisis affected acute stroke care in our center during the first 2 months of lockdown in Spain. Methods: This is a single-center, retrospective study. We collected demographic, clinical, and radiological data; time course; and treatment of patients meeting the stroke unit admission criteria from March 14 to May 14, 2020 (COVID-19 period group). Data were compared with the same period in 2019 (pre-COVID-19 period group). Results: 195 patients were analyzed; 83 in the COVID-19 period group, resulting in a 26% decline of acute strokes and transient ischemic attacks (TIAs) admitted to our center compared with the previous year (p = 0.038). Ten patients (12%) tested positive for PCR SARS-CoV-2. The proportion of patients aged 65 years and over was lower in the COVID-19 period group (53 vs. 68.8%, p = 0.025). During the pandemic period, analyzed patients were more frequently smokers (27.7 vs. 10.7%, p = 0.002) and had less frequently history of prior stroke (13.3 vs. 25%, p = 0.043) or atrial fibrillation (9.6 vs. 25%, p = 0.006). ASPECTS score was lower (9 [7–10] vs. 10 [8–10], p = 0.032), NIHSS score was slightly higher (5 [2–14] vs. 4 [2–8], p = 0.122), onset-to-door time was higher (304 [93–760] vs. 197 [91.25–645] min, p = 0.104), and a lower proportion arrived within 4.5 h from onset of symptoms (43.4 vs. 58%, p = 0.043) during the CO­VID-19 period. There were no differences between proportion of patients receiving recanalization treatment (intravenous thrombolysis and/or mechanical thrombectomy) and in-hospital delays. Conclusion: We observed a reduction in the number of acute strokes and TIAs admitted during the COVID-19 period. This drop affected especially elderly patients, and despite a delay in their arrival to the emergency department, the proportion of patients treated with recanalization therapies was preserved.

Remote Longitudinal Inpatient Acute Stroke Care Via Telestroke

2021 ◽  
Vol 30 (6) ◽  
pp. 105749
Author(s):  
Fatemeh Sobhani ◽  
Shashvat Desai ◽  
Evan Madill ◽  
Matthew Starr ◽  
Marcelo Rocha ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care

Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties

2019 ◽  
Vol 24 (4) ◽  
pp. 505-514 ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Stephen Shiboski ◽  
Barbara Grimes ◽  
Lawrence J. Cook ◽  
David Ghilarducci ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Acute Stroke Care ◽  
Intravenous Alteplase
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