2021
Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity
Wilcock A, Schwamm L, Zubizarreta J, Zachrison K, Uscher-Pines L, Richard J, Mehrotra A. Reperfusion Treatment and Stroke Outcomes in Hospitals With Telestroke Capacity. JAMA Neurology 2021, 78: 527-535. PMID: 33646272, PMCID: PMC7922240, DOI: 10.1001/jamaneurol.2021.0023.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeReperfusion treatmentIschemic strokeShort-term acute carePatients 85 yearsLow-volume hospitalsYear of admissionHospital emergency departmentTraditional Medicare beneficiariesClinical characteristicsCritical access hospitalsStroke outcomeAcute careControl hospitalsEmergency departmentMean ageFunctional statusPrimary diagnosisStroke expertiseHospital characteristicsMAIN OUTCOMEMedicare beneficiariesPatientsHospitalCare patterns
2020
Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Target: Stroke Was Associated With Faster Intravenous Thrombolysis and Improved One-Year Outcomes for Acute Ischemic Stroke in Medicare Beneficiaries. Circulation Cardiovascular Quality And Outcomes 2020, 13: e007150. PMID: 33302714, DOI: 10.1161/circoutcomes.120.007150.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overDatabases, FactualFemaleFibrinolytic AgentsHumansInfusions, IntravenousInsurance BenefitsIschemic StrokeMaleMedicarePatient ReadmissionQuality ImprovementQuality Indicators, Health CareRetrospective StudiesRisk AssessmentRisk FactorsThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsAcute ischemic strokeIschemic strokeNeedle timeIntravenous thrombolysisCardiovascular readmissionCause mortalityThrombolytic treatmentThrombolytic therapyMedicare beneficiariesGuidelines-Stroke hospitalsIntravenous thrombolytic therapyIntravenous thrombolytic treatmentOne-year outcomesProportion of patientsProportional hazards analysisAmerican Heart AssociationQuality InitiativeCause readmissionMedian doorHospital clusteringMedian ageHeart AssociationHospital characteristicsReadmissionImproved doorPatterns of anticonvulsant use and adverse drug events in older adults
Moura L, Smith J, Yan Z, Blacker D, Schwamm L, Newhouse J, Hernandez‐Diaz S, Hsu J. Patterns of anticonvulsant use and adverse drug events in older adults. Pharmacoepidemiology And Drug Safety 2020, 30: 28-36. PMID: 33009718, PMCID: PMC7849867, DOI: 10.1002/pds.5139.Peer-Reviewed Original ResearchConceptsAdverse drug eventsElectronic health recordsIncident usersAnticonvulsant useDrug eventsMedicare beneficiariesRate of ADEsSeverity of ADEsSignificant adverse drug eventsEligible beneficiariesOlder adultsCohort of communityDuration of useRange of indicationsTraditional Medicare beneficiariesInverse probability weightsADE ratesMonotherapy usersSingle anticonvulsantAnticonvulsant therapyPain reliefCommon indicationOriginal cohortNervous systemOlder adult communityAntiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke
Chang K, Xian Y, Zhao X, Mi X, Matsouaka R, Schwamm L, Shah S, Lytle B, Smith E, Bhatt D, Fonarow G, Hsu J. Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke. International Journal Of Cardiology 2020, 321: 88-94. PMID: 32805327, DOI: 10.1016/j.ijcard.2020.08.011.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeAntiplatelet therapyAntithrombotic therapyIschemic strokeTherapy prescriptionOral anticoagulationUnadjusted ratesGuidelines-Stroke registryService beneficiaries 65Retrospective cohort studyOral anticoagulant therapyAnticoagulant therapyCohort studyComposite endpointPrimary outcomeAtrial fibrillationAtrial flutterPotential confoundersNeurologic/Medicare beneficiariesMedicare feeTherapyStrokePatientsMortality
2019
Epilepsy Among Elderly Medicare Beneficiaries
Moura L, Smith J, Blacker D, Vogeli C, Schwamm L, Cole A, Hernandez-Diaz S, Hsu J. Epilepsy Among Elderly Medicare Beneficiaries. Medical Care 2019, 57: 318-324. PMID: 30762723, PMCID: PMC6417929, DOI: 10.1097/mlr.0000000000001072.Peer-Reviewed Original ResearchConceptsMedicare administrative dataEpilepsy statusMedicare beneficiariesMedicare dataEpilepsy diagnosisElectronic health record dataElderly Medicare beneficiariesHealth record dataHealth insurance claimsAdministrative dataElectronic health recordsIncident epilepsyPrevalent epilepsyDrug claimsEpilepsyDiagnostic thresholdStratified random sampleInverse probabilityHealth recordsANTIPLATELET THERAPY PRESCRIPTION PATTERNS AND ASSOCIATIONS WITH CLINICAL OUTCOMES IN MEDICARE BENEFICIARIES WITH ATRIAL FIBRILLATION PRESCRIBED NO ORAL ANTICOAGULATION AFTER ACUTE ISCHEMIC STROKE
Chang K, Xian Y, Zhao X, Matsouaka R, Schwamm L, Fonarow G, Bhatt D, Shah S, Lytle B, Smith E, Hsu J. ANTIPLATELET THERAPY PRESCRIPTION PATTERNS AND ASSOCIATIONS WITH CLINICAL OUTCOMES IN MEDICARE BENEFICIARIES WITH ATRIAL FIBRILLATION PRESCRIBED NO ORAL ANTICOAGULATION AFTER ACUTE ISCHEMIC STROKE. Journal Of The American College Of Cardiology 2019, 73: 364. DOI: 10.1016/s0735-1097(19)30972-6.Peer-Reviewed Original ResearchMedicare claims can identify post-stroke epilepsy
Moura L, Smith J, Blacker D, Vogeli C, Schwamm L, Hsu J. Medicare claims can identify post-stroke epilepsy. Epilepsy Research 2019, 151: 40-47. PMID: 30780120, PMCID: PMC6640134, DOI: 10.1016/j.eplepsyres.2019.02.002.Peer-Reviewed Original ResearchConceptsElectronic health recordsAccountable care organizationsMedicare claimsCommunity-dwelling elderly individualsPost-stroke epilepsyElderly Medicare beneficiariesClaims-based algorithmPositive predictive valuePioneer Accountable Care OrganizationsDiscrete etiologyNeurologist visitOverall prevalenceMedicare patientsClaims diagnosesPSE diagnosisElderly individualsMedicare beneficiariesPatientsPredictive valueEpilepsyFuture epidemiological surveillanceEpidemiological surveillanceInverse probabilityHealth recordsDiagnosis
2018
Incidence of Atrial Fibrillation in Patients With Recent Ischemic Stroke Versus Matched Controls
Witsch J, Merkler AE, Chen ML, Navi BB, Sheth KN, Freedman B, Schwamm LH, Kamel H. Incidence of Atrial Fibrillation in Patients With Recent Ischemic Stroke Versus Matched Controls. Stroke 2018, 49: 2529-2531. PMID: 30355110, PMCID: PMC6205716, DOI: 10.1161/strokeaha.118.022826.Peer-Reviewed Original ResearchConceptsAtrial fibrillation/flutterIschemic strokeHemorrhagic strokeAF incidenceAF diagnosisRisk factorsAF-free patientsNew AF diagnosisVascular risk factorsNonstroke diagnosisAutonomic dysfunctionCharlson comorbidityStroke cohortAtrial fibrillationCox regressionNinth RevisionOutpatient claimsIncidental findingClinical ModificationHigh riskInternational ClassificationMedicare beneficiariesSurvival statisticsMatched ControlsPatients
2017
Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke
Xian Y, Thomas L, Liang L, Federspiel J, Webb L, Bushnell C, Duncan P, Schwamm L, Stein J, Fonarow G, Hoenig H, Montalvo C, George M, Lutz B, Peterson E, Bettger J. Unexplained Variation for Hospitals’ Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke. Stroke 2017, 48: 2836-2842. PMID: 28830975, DOI: 10.1161/strokeaha.117.016904.Peer-Reviewed Original ResearchConceptsInpatient rehabilitation facilitySkilled nursing facilitiesAcute ischemic strokeHospital-level variationIschemic strokeNursing facilitiesGuidelines-Stroke hospitalsMultilevel logistic regression modelsMedian odds ratioGeographic availabilityLogistic regression modelsIRF patientsHospital complicationsSNF patientsClinical characteristicsComorbid conditionsInpatient rehabilitationHospital characteristicsClinical registryOdds ratioRehabilitation facilityHospital useMedicare beneficiariesPatientsHospitalRegional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals
Thompson M, Zhao X, Bekelis K, Gottlieb D, Fonarow G, Schulte P, Xian Y, Lytle B, Schwamm L, Smith E, Reeves M. Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003604. PMID: 28798017, DOI: 10.1161/circoutcomes.117.003604.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedBrain IschemiaDatabases, FactualFee-for-Service PlansFemaleGuideline AdherenceHealth ResourcesHealthcare DisparitiesHospitalsHumansInsurance BenefitsMaleMedicarePatient ReadmissionPractice Guidelines as TopicProcess Assessment, Health CareQuality Indicators, Health CareRegistriesRisk FactorsStrokeTime FactorsTreatment OutcomeUnited StatesConceptsReadmission ratesHospital characteristicsHRR levelHealthcare resourcesGuidelines-Stroke hospitalsGuidelines-Stroke registryHealthcare resource dataIschemic stroke outcomeThirty-day mortalityIschemic stroke mortalityHospital referral region levelStroke outcomeHospital factorsPatient characteristicsStroke mortalityCare measuresMedicare beneficiariesMedicare feeMortalityDartmouth AtlasPatientsRegional variationHealth careOutcomesReadmission
2016
Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke
Song S, Fonarow G, Olson D, Liang L, Schulte P, Hernandez A, Peterson E, Reeves M, Smith E, Schwamm L, Saver J. Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke. Stroke 2016, 47: 1294-1302. PMID: 27079809, PMCID: PMC4975426, DOI: 10.1161/strokeaha.115.011874.Peer-Reviewed Original ResearchConceptsAcute ischemic stroke admissionsGWTG-Stroke programIschemic stroke admissionsClinical outcomesStroke admissionsMedicare beneficiariesAcute care US hospitalsHospital-based quality improvement programsGWTG-Stroke hospitalsImproved functional outcomesAmerican Heart AssociationQuality Improvement ProgramGWTG-StrokePostdischarge mortalityAcute strokeIschemic strokeFunctional outcomeHeart AssociationNonparticipating hospitalsStroke hospitalsHospital participationUS hospitalsHospitalPre periodSimilar hospitalsAssessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries
Fonarow G, Liang L, Thomas L, Xian Y, Saver J, Smith E, Schwamm L, Peterson E, Hernandez A, Duncan P, O'Brien E, Bushnell C, Prvu Bettger J. Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries. Stroke 2016, 47: 836-842. PMID: 26892279, DOI: 10.1161/strokeaha.115.011599.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleIschemic strokeMedicare beneficiariesIschemic stroke Longitudinal (AVAIL) registryMedian Modified Rankin ScaleAcute ischemic strokePatient-centered outcomesSkilled nursing facilitiesGuidelines-StrokeMRS 0Older patientsRankin ScaleStroke careInpatient rehabilitationStroke survivorsC-indexOutcome measuresNursing facilitiesFunctional independenceAdherence evaluationStrokePatientsSimilar findingsMeaningful outcomesPearson correlation coefficient
2012
Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity
Fonarow G, Pan W, Saver J, Smith E, Reeves M, Broderick J, Kleindorfer D, Sacco R, Olson D, Hernandez A, Peterson E, Schwamm L. Comparison of 30-Day Mortality Models for Profiling Hospital Performance in Acute Ischemic Stroke With vs Without Adjustment for Stroke Severity. JAMA 2012, 308: 257-264. PMID: 22797643, DOI: 10.1001/jama.2012.7870.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNIHSS scoreInitial stroke severityIschemic strokeStroke severityMedicare beneficiariesClaims-based risk modelsHospital mortality modelMean NIHSS scoreRisk-standardized outcomesHealth Stroke ScaleNet reclassification improvementDiscrimination improvement indexService Medicare beneficiariesHospital mortality risk modelMortality risk modelProfiling Hospital PerformanceGuidelines-StrokeIndex hospitalizationStroke ScaleReclassification improvementRisk modelModel discriminationPotential eligibilityStudy populationRelationship of National Institutes of Health Stroke Scale to 30-Day Mortality in Medicare Beneficiaries With Acute Ischemic Stroke
Fonarow G, Saver J, Smith E, Broderick J, Kleindorfer D, Sacco R, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Relationship of National Institutes of Health Stroke Scale to 30-Day Mortality in Medicare Beneficiaries With Acute Ischemic Stroke. Journal Of The American Heart Association 2012, 1: 42-50. DOI: 10.1161/xjaha.111.000034.Peer-Reviewed Original ResearchImproved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke during Initial Implementation of the Get with the Guidelines-Stroke Program 2003-2008 (IN2-2.002)
Song S, Fonarow G, Pan W, Olson D, Hernandez A, Peterson E, Reeves M, Smith E, Schwamm L, Saver J. Improved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke during Initial Implementation of the Get with the Guidelines-Stroke Program 2003-2008 (IN2-2.002). Neurology 2012, 78: in2-2.002-in2-2.002. DOI: 10.1212/wnl.78.1_meetingabstracts.in2-2.002.Peer-Reviewed Original ResearchAcute ischemic strokeImproved clinical outcomesIschemic strokeClinical outcomesMedicare beneficiariesStrokeImproved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke during Initial Implementation of the Get with the Guidelines-Stroke Program 2003-2008 (S19.003)
Song S, Fonarow G, Pan W, Olson D, Hernandez A, Peterson E, Reeves M, Smith E, Schwamm L, Saver J. Improved Clinical Outcomes in Medicare Beneficiaries with Acute Ischemic Stroke during Initial Implementation of the Get with the Guidelines-Stroke Program 2003-2008 (S19.003). Neurology 2012, 78: s19.003-s19.003. DOI: 10.1212/wnl.78.1_meetingabstracts.s19.003.Peer-Reviewed Original ResearchAcute ischemic strokeImproved clinical outcomesIschemic strokeClinical outcomesMedicare beneficiariesStrokeRelationship of National Institutes of Health Stroke Scale to 30‐Day Mortality in Medicare Beneficiaries With Acute Ischemic Stroke
Fonarow G, Saver J, Smith E, Broderick J, Kleindorfer D, Sacco R, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Relationship of National Institutes of Health Stroke Scale to 30‐Day Mortality in Medicare Beneficiaries With Acute Ischemic Stroke. Journal Of The American Heart Association 2012, 1: 42-50. PMID: 23130117, PMCID: PMC3487316, DOI: 10.1161/jaha.111.000034.Peer-Reviewed Original ResearchAcute ischemic strokeHealth Stroke ScaleIschemic strokeMedicare beneficiariesNIHSS scoreStroke ScaleStroke severityMortality riskMortality rateGuidelines-Stroke hospitalsMedian NIHSS scoreSubstantial prognostic informationInitial stroke severityDiscrimination of riskService Medicare beneficiariesNational InstituteContinuous variablesMean ageC-statisticPrognostic informationRisk discriminationNIHSSClinical informationGraded relationStroke
2011
Representativeness of the Get With The Guidelines–Stroke Registry
Reeves M, Fonarow G, Smith E, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Representativeness of the Get With The Guidelines–Stroke Registry. Stroke 2011, 43: 44-49. PMID: 21980197, DOI: 10.1161/strokeaha.111.626978.Peer-Reviewed Original ResearchConceptsIschemic stroke admissionsGWTG-Stroke hospitalsGWTG-StrokeMedicare cohortStroke admissionsStroke hospitalsIschemic strokePatient characteristicsMedicare patientsGuidelines-Stroke registryGWTG-Stroke programIschemic stroke populationService Medicare patientsAcute ischemic strokeLength of stayHospital mortalityDischarge homeHospital outcomesAcute strokeStroke populationHospital characteristicsMedicare beneficiariesAdmissionHospitalNational feeResponse to Letter by Khan et al Regarding Article, “Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke”
Fonarow G, Smith E, Schwamm L. Response to Letter by Khan et al Regarding Article, “Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke”. Stroke 2011, 42: e405. DOI: 10.1161/strokeaha.111.614909.Peer-Reviewed Original Research
2010
Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke
Fonarow G, Smith E, Reeves M, Pan W, Olson D, Hernandez A, Peterson E, Schwamm L. Hospital-Level Variation in Mortality and Rehospitalization for Medicare Beneficiaries With Acute Ischemic Stroke. Stroke 2010, 42: 159-166. PMID: 21164109, DOI: 10.1161/strokeaha.110.601831.Peer-Reviewed Original ResearchConceptsIschemic strokeMedicare beneficiariesReadmission ratesPrimary stroke center designationGuidelines-Stroke hospitalsHospital-level outcomesStroke center designationAcute ischemic strokeCause readmission rateIschemic stroke mortalityHospital-level variationCause of deathRisk-adjusted outcomesHospital-level performanceRisk-adjusted ratesHospital dischargeRehospitalization ratesUnadjusted mortalityHospital admissionMean ageCenter designationStroke mortalityFavorable outcomeAcademic hospitalOutcome data