2023
Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach
Zachrison K, Hsia R, Schwamm L, Yan Z, Samuels-Kalow M, Reeves M, Camargo C, Onnela J. Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach. Circulation Cardiovascular Quality And Outcomes 2023, 16: e009868. PMID: 37746725, PMCID: PMC10592016, DOI: 10.1161/circoutcomes.122.009868.Peer-Reviewed Original ResearchConceptsInsurance-based disparitiesStroke centersEmergency departmentHospital clustersInitial emergency departmentIschemic stroke admissionsHospital emergency departmentClusters of hospitalsLogistic regression modelsStroke admissionsUninsured patientsPatient insuranceLower oddsPatientsLess strokeCenter accessOddsCenter transferHospitalLikelihood of transferInsurance groupsRegression modelsLower proportionDepartmentAssociation
2022
Estimated Population Access to Acute Stroke and Telestroke Centers in the US, 2019
Zachrison K, Cash R, Adeoye O, Boggs K, Schwamm L, Mehrotra A, Camargo C. Estimated Population Access to Acute Stroke and Telestroke Centers in the US, 2019. JAMA Network Open 2022, 5: e2145824. PMID: 35138392, PMCID: PMC8829668, DOI: 10.1001/jamanetworkopen.2021.45824.Peer-Reviewed Original Research
2021
National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic
Zachrison KS, Sharma R, Wang Y, Mehrotra A, Schwamm LH. National Trends in Telestroke Utilization in a US Commercial Platform Prior to the COVID-19 Pandemic. Journal Of Stroke And Cerebrovascular Diseases 2021, 30: 106035. PMID: 34419836, PMCID: PMC8494566, DOI: 10.1016/j.jstrokecerebrovasdis.2021.106035.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCOVID-19Databases, FactualFemaleFibrinolytic AgentsHumansMaleMiddle AgedPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRemote ConsultationStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsIschemic stroke patientsTelestroke consultationAlteplase deliveryStroke patientsNumber of patientsNumber of consultsCOVID-19 public health emergencyPublic health emergencyAlteplase useMedian doorNeedle timeStroke severityED arrivalEmergency departmentImaging reviewHospital characteristicsTelestroke networkCT scanHospital participationSpoke sitesProvider groupsPatientsHospital sizeStudy periodHealth emergencyRising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments
Uscher-Pines L, Sousa J, Mehrotra A, Schwamm L, Zachrison K. Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments. Journal Of The American Medical Informatics Association 2021, 28: 1910-1918. PMID: 34022045, PMCID: PMC8194856, DOI: 10.1093/jamia/ocab092.Peer-Reviewed Original ResearchConceptsEmergency departmentTelehealth programED leadersU.S. emergency departmentsCoronavirus disease 2019 (COVID-19) pandemicDisease 2019 pandemicPersonal protective equipmentTelehealth applicationsPostdischarge assessmentsAcute careVirus exposureVisit volumeOngoing COVID-19Telehealth implementationTele-triageMaximum variation samplingProtective equipmentTelehealth innovationCOVID-19Tele-consultationCOVID-19 pandemicImplementation supportCarePandemicLiterature reviewAccess to Mechanical Thrombectomy for Ischemic Stroke in the United States
Kamel H, Parikh N, Chatterjee A, Kim L, Saver J, Schwamm L, Zachrison K, Nogueira R, Adeoye O, Díaz I, Ryan A, Pandya A, Navi B. Access to Mechanical Thrombectomy for Ischemic Stroke in the United States. Stroke 2021, 52: 2554-2561. PMID: 33980045, PMCID: PMC8316281, DOI: 10.1161/strokeaha.120.033485.Peer-Reviewed Original ResearchConceptsIschemic strokeMechanical thrombectomyUnadjusted logistic regression modelsNonfederal emergency departmentsAcute ischemic strokeLarge cerebral vesselsAcute care hospitalsMultiple sensitivity analysesLogistic regression modelsStandard descriptive statisticsIntravenous thrombolysisStroke severityUrban patientsCare hospitalSuch patientsInterhospital transferRural patientsStroke careEmergency departmentPopulation-wide dataCerebral vesselsThrombectomyCalendar year 2016PatientsPrimary analysisReperfusion 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 patternsTelehealth use in emergency care during coronavirus disease 2019: a systematic review
Jaffe T, Hayden E, Uscher‐Pines L, Sousa J, Schwamm L, Mehrotra A, Zachrison K. Telehealth use in emergency care during coronavirus disease 2019: a systematic review. Journal Of The American College Of Emergency Physicians Open 2021, 2: e12443. PMID: 33969356, PMCID: PMC8087945, DOI: 10.1002/emp2.12443.Peer-Reviewed Original ResearchCoronavirus disease 2019 (COVID-19) pandemicDisease 2019 pandemicEmergency departmentCoronavirus disease 2019Emergency careTelehealth useDisease 2019Systematic reviewCare deliveryAcute care needsHealth care workersTelehealth initiativesEmergency care deliveryCohort studyClinical trialsPatient outcomesCare needsCare workersTelehealth programPatient careMedical literatureCareTelehealthGrey literatureCost data
2020
Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases
Zachrison K, Li S, Reeves M, Adeoye O, Camargo C, Schwamm L, Hsia R. Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases. Stroke And Vascular Neurology 2020, 6: 194-200. PMID: 33177162, PMCID: PMC8258073, DOI: 10.1136/svn-2020-000533.Peer-Reviewed Original ResearchConceptsICD-9/ICDMS-DRG codesCurrent Procedural TerminologyEndovascular thrombectomyICD-10 codesLarge administrative databaseIschemic strokeICD codesDischarge codesEmergency departmentAdministrative databasesICD-9CPT codesThrombolytic-treated patientsMedicare severity diagnosisAdministrative dataInpatient hospitalisationThrombolytic treatmentED patientsInterhospital transferDiagnosis codesStroke researchInternational ClassificationPatientsProcedural TerminologyDigital triage: Novel strategies for population health management in response to the COVID-19 pandemic
Lai L, Wittbold K, Dadabhoy F, Sato R, Landman A, Schwamm L, He S, Patel R, Wei N, Zuccotti G, Lennes I, Medina D, Sequist T, Bomba G, Keschner Y, Zhang H. Digital triage: Novel strategies for population health management in response to the COVID-19 pandemic. Healthcare 2020, 8: 100493. PMID: 33129176, PMCID: PMC7586929, DOI: 10.1016/j.hjdsi.2020.100493.Peer-Reviewed Original ResearchConceptsPre-hospital triagePotential viral transmissionHealthcare system capacityPopulation health managementCOVID-19 pandemicEmergency departmentCOVID-19 casesAppropriate careU.S. healthcare systemClinical staffViral transmissionPatient demandPartners HealthCareHealthcare systemCOVID-19PatientsCareNovel strategyHealth managementArtificial intelligenceHospitalizationPandemicUnique challengesClinicClinicians
2019
Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals
Menon B, Xu H, Cox M, Saver J, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt D, Fonarow G, Schwamm L, Smith E. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019, 139: 169-179. PMID: 30586703, DOI: 10.1161/circulationaha.118.036701.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke hospitalsEndovascular therapyHospital-level variablesShorter doorArterial accessCase volumeFirst pass timeArterial puncture timeComprehensive stroke centerLarge vessel occlusionCalendar year quarterWorkflow timesSignificant linear time trendsIschemic strokeLonger doorMedian doorStroke centersArterial punctureDiabetes mellitusMultivariable analysisPuncture timeFaster doorEmergency departmentClinical trialsMultivariable modeling
2018
Implementation of a Rapid, Protocol-based TIA Management Pathway
Jarhult S, Howell M, Barnaure-Nachbar I, Chang Y, White B, Amatangelo M, Brown D, Singhal A, Schwamm L, Silverman S, Goldstein J. Implementation of a Rapid, Protocol-based TIA Management Pathway. Western Journal Of Emergency Medicine 2018, 19: 216-223. PMID: 29560046, PMCID: PMC5851491, DOI: 10.5811/westjem.2017.9.35341.Peer-Reviewed Original ResearchConceptsTransient ischemic attackTotal hospital LOSHospital LOSEmergency departmentED LOSFinal diagnosisRecurrent transient ischemic attacksTertiary care academic centerED observation unitIntermediate-risk patientsHigh-risk patientsProportion of patientsMedian ED LOSInpatient admission ratesNeck CT angiographyBrain magnetic resonanceNeck MR angiographyStandardized clinical protocolUse of neuroimagingIschemic attackCohort studyTIA symptomsConsecutive patientsED lengthSix-month period
2017
Characterizing New England Emergency Departments by Telemedicine Use
Zachrison K, Hayden E, Schwamm L, Espinola J, Sullivan A, Boggs K, Raja A, Camargo C. Characterizing New England Emergency Departments by Telemedicine Use. Western Journal Of Emergency Medicine 2017, 18: 1055-1060. PMID: 29085537, PMCID: PMC5654874, DOI: 10.5811/westjem.2017.8.34880.Peer-Reviewed Original ResearchConceptsNew England Emergency DepartmentsRural emergency departmentsEmergency departmentTelemedicine useED characteristicsLow-volume emergency departmentsMultivariable logistic regressionConsultant availabilityIndependent predictorsMultivariable analysisPatient careLogistic regressionPlastic surgeryClinical applicationDescriptive statisticsTelemedicineEngland surveyPrimary objectiveAnnual volumeDepartmentNew England statesPsychiatrySurgeryPediatricsStroke
2014
Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke
Xian Y, Smith E, Zhao X, Peterson E, Olson D, Hernandez A, Bhatt D, Saver J, Schwamm L, Fonarow G. Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke. Stroke 2014, 45: 1387-1395. PMID: 24713527, DOI: 10.1161/strokeaha.113.003898.Peer-Reviewed Original ResearchConceptsShorter DTN timesAcute ischemic strokeTissue-type plasminogen activatorDTN timeIschemic strokePlasminogen activatorIntravenous tissue-type plasminogen activatorTissue-type plasminogen activator treatmentTissue-type plasminogen activator administrationGuidelines-Stroke hospitalsMedian DTN timePlasminogen activator treatmentHospital strategiesNeedle timeSymptom onsetMultivariable analysisBaseline useEmergency departmentRapid doorActivator treatmentHospitalStrokeActivation systemAssociationActivator
2012
Predictors of Rapid Brain Imaging in Acute Stroke
Kelly A, Hellkamp A, Olson D, Smith E, Schwamm L. Predictors of Rapid Brain Imaging in Acute Stroke. Stroke 2012, 43: 1279-1284. PMID: 22442169, DOI: 10.1161/strokeaha.111.626374.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedDiabetes MellitusEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHumansMagnetic Resonance ImagingMaleMultivariate AnalysisNeuroimagingPractice Guidelines as TopicRacial GroupsRetrospective StudiesSex FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsEmergency department arrivalBrain imagingSymptom onsetHealth Stroke Scale scoreFuture quality improvement initiativesGuidelines-Stroke programStroke Scale scoreStroke symptom onsetAcute stroke symptomsHistory of diabetesPeripheral vascular diseaseMultivariable logistic regressionQuality improvement initiativesEffectiveness of thrombolysisOverall imaging rateProsthetic heart valvesPredictive variablesAcute strokeMost patientsHospital clusteringIndependent predictorsStroke symptomsNonwhite raceEmergency departmentVascular disease
2010
The “Golden Hour” and Acute Brain Ischemia
Saver J, Smith E, Fonarow G, Reeves M, Zhao X, Olson D, Schwamm L. The “Golden Hour” and Acute Brain Ischemia. Stroke 2010, 41: 1431-1439. PMID: 20522809, PMCID: PMC2909671, DOI: 10.1161/strokeaha.110.583815.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHospital emergency departmentIntravenous thrombolytic therapyAcute brain ischemiaNeedle timeThrombolytic therapyStroke patientsEmergency departmentGolden hourBrain ischemiaGreater stroke severityGuidelines-Stroke databaseQuarter of patientsHours of onsetHours patientsStroke severityDoor timeEarly presentationPatientsWell timeStudy periodTherapyIschemiaOnset timeMinutes
2009
Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic strokeSYMBOL
Rost N, Masrur S, Pervez M, Viswanathan A, Schwamm L. Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic strokeSYMBOL. Neurology 2009, 73: 1957-1962. PMID: 19940272, PMCID: PMC4109188, DOI: 10.1212/wnl.0b013e3181c5b46d.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorEmergency departmentAbsolute contraindicationStroke patientsAmerican Heart Association/American Stroke Association guidelinesAcute ischemic stroke patientsAmerican Stroke Association guidelinesGuidelines-Stroke databaseIschemic stroke patientsCurrent practice guidelinesReferral centerRelative contraindicationThrombolysis patientsEarly administrationRetrospective reviewStroke databaseThrombolytic therapyTreatable factorsDiagnostic neuroimagingAssociation guidelinesClinical evaluationPractice guidelinesBleeding diathesisCoagulopathyPatientsA Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care
Schwamm L, Holloway R, Amarenco P, Audebert H, Bakas T, Chumbler N, Handschu R, Jauch E, Knight W, Levine S, Mayberg M, Meyer B, Meyers P, Skalabrin E, Wechsler L. A Review of the Evidence for the Use of Telemedicine Within Stroke Systems of Care. Stroke 2009, 40: 2616-2634. PMID: 19423852, DOI: 10.1161/strokeaha.109.192360.Peer-Reviewed Original ResearchConceptsUse of telemedicineStroke systemsStroke treatmentAmerican Heart Association/American CollegeStroke care deliveryAcute stroke treatmentEvidence-based reviewEvidence-based recommendationsEmergency medical servicesSecondary preventionNeurological assessmentPrimary preventionEmergency departmentCardiology FoundationConsensus recommendationsAmerican CollegeClass of evidenceCare deliveryAvailable evidenceCare frameworkMedical servicesPreventionTelemedicineTreatmentLevel of certainty
2004
Virtual TeleStroke Support for the Emergency Department Evaluation of Acute Stroke
Schwamm L, Rosenthal E, Hirshberg A, Schaefer P, Little E, Kvedar J, Petkovska I, Koroshetz W, Levine S. Virtual TeleStroke Support for the Emergency Department Evaluation of Acute Stroke. Academic Emergency Medicine 2004, 11: 1193-1197. PMID: 15528584, DOI: 10.1197/j.aem.2004.08.014.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorAcute strokeTelestroke consultationNeedle timeSymptom onsetEmergency departmentHealth Stroke Scale scoreIntravenous tissue plasminogen activatorMean National InstitutesPossible acute strokeEmergency department evaluationStroke Scale scoreAcute ischemic strokeEvaluation of patientsEligible patientsStroke neurologistsIschemic strokeDepartment evaluationNeurologic examinationRandomized trialsStroke expertiseProtocol violationsEmergency physiciansInter-rater reliabilityPatient management