2021
Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention
Xian Y, Xu H, Smith E, Saver J, Reeves M, Bhatt D, Hernandez A, Peterson E, Schwamm L, Fonarow G. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke 2021, 53: 1328-1338. PMID: 34802250, DOI: 10.1161/strokeaha.121.035853.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeProportion of patientsIschemic strokeNeedle timeSymptom onsetClinical outcomesNationwide quality improvement initiativePhase IBenefits of tPAGuidelines-Stroke hospitalsMedian DTN timeSecond intervention periodStroke symptom onsetQuality improvement interventionsQuality improvement initiativesPhase IIQuality Improvement ProgramHigh rateMinutes preinterventionBleeding complicationsHospital mortalityDTN timeHospital arrivalTPA useTherapy start
2018
Participation in Get With the Guidelines–Stroke and Its Association With Quality of Care for Stroke
Howard G, Schwamm LH, Donnelly JP, Howard VJ, Jasne A, Smith EE, Rhodes JD, Kissela BM, Fonarow GC, Kleindorfer DO, Albright KC. Participation in Get With the Guidelines–Stroke and Its Association With Quality of Care for Stroke. JAMA Neurology 2018, 75: 1331-1337. PMID: 30083763, PMCID: PMC6248106, DOI: 10.1001/jamaneurol.2018.2101.Peer-Reviewed Original ResearchConceptsTissue plasminogen activatorIschemic strokeQuality of careGuidelines-StrokeGWTG-StrokeMean ageNonparticipating hospitalsCare measuresRisk factorsPopulation-based cohort studyPlasminogen activatorLipid profile assessmentParticipants 45 yearsStroke risk factorsQuality Improvement ProgramEvidence-based interventionsExercise counselingNeurologist evaluationAntithrombotic therapyCohort studyAntithrombotic useStroke careMAIN OUTCOMELipid evaluationHospital
2017
Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke
Kamal N, Sheng S, Xian Y, Matsouaka R, Hill M, Bhatt D, Saver J, Reeves M, Fonarow G, Schwamm L, Smith E. Delays in Door-to-Needle Times and Their Impact on Treatment Time and Outcomes in Get With The Guidelines-Stroke. Stroke 2017, 48: 946-954. PMID: 28228574, DOI: 10.1161/strokeaha.116.015712.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDelivery of Health CareFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedOutcome and Process Assessment, Health CareOutcome Assessment, Health CareStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorConceptsNeedle timeGuidelines-StrokeAcute ischemic stroke patientsSymptomatic intracranial hemorrhageIschemic stroke patientsQuality Improvement ProgramTissue-type plasminogen activatorAcute comorbiditiesHospital mortalityInpatient strokeIntravenous alteplaseLonger doorIndependent ambulationDelay diagnosisIntracranial hemorrhageStroke patientsHospital characteristicsPatient outcomesHigher oddsLower oddsPatientsPlasminogen activatorStroke recognitionHospitalDiagnosis
2016
Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow G, Schwamm L, Hu B, Peterson E, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016, 47: 2843-2849. PMID: 27758941, DOI: 10.1161/strokeaha.116.014143.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryIntravenous thrombolytic therapyNational Stroke RegistryQuality Improvement ProgramHigher composite scoresStroke RegistryDysphagia screeningStroke careThrombolytic therapyAtrial fibrillationSmoking cessationLeading causeStroke educationMultivariate analysisStudy periodAdherenceComposite scoreHospitalPhase 2Phase 1CareRegression modelsOddsOverall qualitySignificant improvementAssociation 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 hospitals
2014
Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool
Olson D, Cox M, Constable M, Britz G, Lin C, Zimmer L, Fonarow G, Schwamm L, Peterson E. Development and Initial Testing of the Stroke Rapid-Treatment Readiness Tool. Journal Of Neuroscience Nursing 2014, 46: 267-273. PMID: 25099063, PMCID: PMC4165480, DOI: 10.1097/jnn.0000000000000082.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorPlasminogen activatorQuality Improvement ProgramGuidelines-StrokeEligible patientsHospital arrivalIschemic strokeNeedle timeHealth systemU.S. hospitalsHospitalReadiness ToolInitial testingLikert scale surveyPatientsActivatorImprovement programsStrokeAdministration
2012
Trends in Smoking Cessation Counseling: Experience From American Heart Association‐Get With The Guidelines
Huang P, Kim C, Lerman A, Cannon C, Dai D, Laskey W, Peacock W, Hernandez A, Peterson E, Smith E, Fonarow G, Schwamm L, Bhatt D. Trends in Smoking Cessation Counseling: Experience From American Heart Association‐Get With The Guidelines. Clinical Cardiology 2012, 35: 396-403. PMID: 22753250, PMCID: PMC6652349, DOI: 10.1002/clc.22023.Peer-Reviewed Original ResearchMeSH KeywordsAgedAmerican Heart AssociationCardiovascular DiseasesChi-Square DistributionCounselingFemaleGuideline AdherenceHumansMaleMiddle AgedMultivariate AnalysisPractice Guidelines as TopicQuality ImprovementRisk AssessmentRisk FactorsRisk Reduction BehaviorSmokingSmoking CessationSmoking PreventionTime FactorsUnited StatesConceptsAmerican Heart AssociationGWTG-CADGWTG-StrokeHeart AssociationSystematic quality improvement programmeCoronary artery disease patientsNational guideline recommendationsSuccessful smoking cessationQuality Improvement ProgramCessation counselingSmoking contributesStroke admissionsGuideline recommendationsRecent smokersSignificant morbidityStroke careStroke patientsSmoking cessationDisease patientsCardiovascular carePatientsAdmissionStudy periodStrokeCareRegional Variation in Recommended Treatments for Ischemic Stroke and TIA
Allen NB, Kaltenbach L, Goldstein LB, Olson DM, Smith EE, Peterson ED, Schwamm L, Lichtman JH. Regional Variation in Recommended Treatments for Ischemic Stroke and TIA. Stroke 2012, 43: 1858-1864. PMID: 22588262, DOI: 10.1161/strokeaha.112.652305.Peer-Reviewed Original ResearchConceptsDefect-free careLipid-lowering medicationsTissue-type plasminogen activatorLower oddsIschemic strokeIntravenous tissue-type plasminogen activatorSecondary stroke prevention treatmentDeep vein thrombosis prophylaxisTissue-type plasminogen activator administrationNational quality improvement programPlasminogen activatorGuideline-recommended treatmentGuidelines-Stroke hospitalsTransient ischemic attackQuarter of patientsStroke prevention treatmentBetter patient outcomesWeight loss educationQuality Improvement ProgramEligible patientsIschemic attackThrombosis prophylaxisPatient demographicsStroke treatmentMedical historyData quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit
Xian Y, Fonarow G, Reeves M, Webb L, Blevins J, Demyanenko V, Zhao X, Olson D, Hernandez A, Peterson E, Schwamm L, Smith E. Data quality in the American Heart Association Get With The Guidelines-Stroke (GWTG-Stroke): Results from a National Data Validation Audit. American Heart Journal 2012, 163: 392-398.e1. PMID: 22424009, DOI: 10.1016/j.ahj.2011.12.012.Peer-Reviewed Original ResearchConceptsMedical recordsDeep venous thrombosis prophylaxisPrimary stroke center certificationGWTG-Stroke hospitalsHospital academic statusStroke center certificationVenous thrombosis prophylaxisNational Stroke RegistryAmerican Heart AssociationQuality Improvement ProgramIntraclass correlationIschemic stroke volumeGuidelines-StrokeGWTG-StrokeStroke RegistryThrombosis prophylaxisNeedle timeSerum creatinineSymptom onsetHeart AssociationCenter certificationStroke volumeRegistry dataRegistry participationCategorical variables
2011
Comparison of Composite Measure Methodologies for Rewarding Quality of Care
Eapen Z, Fonarow G, Dai D, O'Brien S, Schwamm L, Cannon C, Heidenreich P, Bhatt D, Peterson E, Hernandez A. Comparison of Composite Measure Methodologies for Rewarding Quality of Care. Circulation Cardiovascular Quality And Outcomes 2011, 4: 610-618. PMID: 22010200, DOI: 10.1161/circoutcomes.111.961391.Peer-Reviewed Original ResearchConceptsReadmission ratesHospital rankingsRisk-standardized readmission ratesRisk-standardized mortality ratesOpportunity-based scoreAcute myocardial infarctionBottom quintileComposite scoreModest correlationQuality Improvement ProgramComposite measureCause mortalityNumber of hospitalsHealth care performanceMyocardial infarctionMortality rateHospitalCare performanceScoresSimilar changesMortalityQuintileObservational analysisComposite performance measure
2010
Development of Stroke Performance Measures
Reeves M, Parker C, Fonarow G, Smith E, Schwamm L. Development of Stroke Performance Measures. Stroke 2010, 41: 1573-1578. PMID: 20489174, DOI: 10.1161/strokeaha.109.577171.Peer-Reviewed Original ResearchConceptsStroke performance measuresStroke careStroke measuresHospital-based stroke careProcess-based performance measuresDeep vein thrombosis prophylaxisStroke quality improvementStroke unit carePatient-oriented outcomesQuality of careQuality Improvement ProgramIntravenous thrombolysisThrombosis prophylaxisAcute strokeIschemic strokeUnit careDysphagia screeningFunctional recoveryPatient outcomesInpatient careCardiovascular diseaseStroke educationLiterature searchCareStrokeRace/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke
Schwamm L, Reeves M, Pan W, Smith E, Frankel M, Olson D, Zhao X, Peterson E, Fonarow G. Race/Ethnicity, Quality of Care, and Outcomes in Ischemic Stroke. Circulation 2010, 121: 1492-1501. PMID: 20308617, DOI: 10.1161/circulationaha.109.881490.Peer-Reviewed Original ResearchConceptsQuality of careWhite patientsRace/ethnicityHospital mortalityIschemic strokeHispanic patientsBlack patientsDeep vein thrombosis prophylaxisEvidence-based care processesGuidelines-Stroke programStroke performance measuresHospital-level variablesQuality Improvement ProgramRace/ethnicity groupsDischarge antithromboticsIntravenous thrombolysisRecurrent strokeThrombosis prophylaxisDiabetes mellitusStroke careAtrial fibrillationMedian lengthSmoking cessationLipid therapyHigher odds
2009
Frequency and Determinants of Lipid Testing in Ischemic Stroke and Transient Ischemic Attack
Smith E, Pan W, Olson D, Reeves M, Ovbiagele B, Peterson E, Fonarow G, Schwamm L. Frequency and Determinants of Lipid Testing in Ischemic Stroke and Transient Ischemic Attack. Stroke 2009, 41: 232-238. PMID: 20035071, DOI: 10.1161/strokeaha.109.567693.Peer-Reviewed Original ResearchConceptsTransient ischemic attackIschemic attackLDL measurementIschemic strokeLipid testingLarger quality improvement programmesLow-density lipoprotein testingTransient ischemic attack admissionsAdditional calendar yearConsecutive ischemic strokeGuidelines-Stroke hospitalsNationwide stroke registryLipid-lowering therapyHistory of strokeQuality Improvement ProgramLogistic regression modelsStroke RegistryHospitalized patientsLipoprotein testingAtrial fibrillationLDL levelsClinical managementHospital characteristicsNational guidelinesPatients
2008
Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack
Schwamm L, Fonarow G, Reeves M, Pan W, Frankel M, Smith E, Ellrodt G, Cannon C, Liang L, Peterson E, LaBresh K. Get With the Guidelines–Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack. Circulation 2008, 119: 107-115. PMID: 19075103, DOI: 10.1161/circulationaha.108.783688.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAcute DiseaseAgedAged, 80 and overEvidence-Based MedicineFemaleGuideline AdherenceHospitalizationHospitals, CommunityHumansIschemic Attack, TransientLogistic ModelsMaleMiddle AgedMultivariate AnalysisProspective StudiesQuality of Health CareRisk FactorsStrokeThrombolytic TherapyConceptsTransient ischemic attackGuidelines-StrokeIschemic attackDeep vein thrombosis prophylaxisNational quality improvement programStroke performance measuresTreatment of strokeEvidence-based guidelinesMain outcome measuresLow-density lipoproteinQuality Improvement ProgramComposite measureDischarge antithromboticsEarly antithromboticsThrombosis prophylaxisIntravenous thrombolyticsAcute strokeIschemic strokeGuideline recommendationsStroke careAtrial fibrillationLipid treatmentCommunity hospitalOutcome measuresSustained improvementDifferential Use of Warfarin for Secondary Stroke Prevention in Patients With Various Types of Atrial Fibrillation
Lewis W, Fonarow G, LaBresh K, Cannon C, Pan W, Super D, Sorof S, Schwamm L. Differential Use of Warfarin for Secondary Stroke Prevention in Patients With Various Types of Atrial Fibrillation. The American Journal Of Cardiology 2008, 103: 227-231. PMID: 19121441, PMCID: PMC3086549, DOI: 10.1016/j.amjcard.2008.08.062.Peer-Reviewed Original ResearchConceptsECG-documented atrial fibrillationType of AFAtrial fibrillationQuality Improvement ProgramEligible patientsStroke preventionHistory of AFForm of AFSuch high-risk groupsSecondary stroke preventionTransient ischemic attackParoxysmal atrial fibrillationHigh-risk groupAnticoagulation guidelinesIschemic attackWarfarin useAnticoagulation therapyThromboembolic eventsElderly patientsHospital dischargeIschemic strokePresent admissionWarfarin therapyWarfarin treatmentMedical history