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 emergency
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 doorWhat Drives Greater Assimilation of Telestroke in Emergency Departments?
Uscher-Pines L, Sousa J, Zachrison K, Guzik A, Schwamm L, Mehrotra A. What Drives Greater Assimilation of Telestroke in Emergency Departments? Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 105310. PMID: 32992169, PMCID: PMC7686253, DOI: 10.1016/j.jstrokecerebrovasdis.2020.105310.Peer-Reviewed Original ResearchAttitude of Health PersonnelClinical ProtocolsDelivery of Health Care, IntegratedEmergency Service, HospitalHealth Knowledge, Attitudes, PracticeHumansInterviews as TopicLeadershipPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareReferral and ConsultationStrokeTelemedicineWorkflow
2019
Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States
Zachrison K, Onnela J, Reeves M, Hernandez A, Camargo C, Zhao X, Matsouaka R, Goldstein J, Metlay J, Schwamm L. Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States. Journal Of The American Heart Association 2019, 9: e011575. PMID: 31888430, PMCID: PMC6988147, DOI: 10.1161/jaha.118.011575.Peer-Reviewed Original ResearchMeSH KeywordsCatchment Area, HealthDatabases, FactualDelivery of Health Care, IntegratedFibrinolytic AgentsHospitalsHospitals, High-VolumeHospitals, Low-VolumeHumansMedicarePatient TransferPractice Patterns, Physicians'Quality Indicators, Health CareRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeAlteplase administrationIschemic strokeUS hospitalsHospital qualityHospital stroke volumeTransfer destinationsHospital referral regionsHospital factorsNumber of hospitalsStroke patientsHospital characteristicsStroke volumeMedicare claimsReferral regionsHospitalLogistic regressionStrokePatientsHospital performancePotential strategyAdministrationHome timeResult dataConnected dyadsA Network Approach to Stroke Systems of Care
Zachrison K, Dhand A, Schwamm L, Onnela J. A Network Approach to Stroke Systems of Care. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005526. PMID: 31405293, PMCID: PMC6822608, DOI: 10.1161/circoutcomes.119.005526.Peer-Reviewed Original ResearchDigital Health Strategies to Improve Care and Continuity Within Stroke Systems of Care in the United States
Schwamm L. Digital Health Strategies to Improve Care and Continuity Within Stroke Systems of Care in the United States. Circulation 2019, 139: 149-151. PMID: 30615498, DOI: 10.1161/circulationaha.117.029234.Peer-Reviewed Original Research
2018
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, Peterson E, Schwamm L, Fonarow G, Smith S, Bettger J, Wang D, Li H, Xian Y, Wang Y. Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2018, 11: e001968. PMID: 30557048, DOI: 10.1161/circoutcomes.115.001968.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaChinaClinical CompetenceDisability EvaluationEvidence-Based MedicineFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk FactorsSmoking CessationStrokeStroke RehabilitationThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeConceptsAcute ischemic strokeIschemic strokeOptimal complianceStroke careChina National Stroke RegistryEvidence-based performance measuresMultivariable Cox modelNational Stroke RegistryFavorable functional outcomeProspective cohort studyEvidence-based guidelinesRoutine clinical practiceCause of deathIntravenous tPAStroke recurrenceStroke RegistryCohort studyNationwide registryClinical outcomesFunctional outcomeCare measuresImproved outcomesHospital measuresCox modelClinical practiceEffect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial
Wang Y, Li Z, Zhao X, Wang C, Wang X, Wang D, Liang L, Liu L, Wang C, Li H, Shen H, Bettger J, Pan Y, Jiang Y, Yang X, Zhang C, Han X, Meng X, Yang X, Kang H, Yuan W, Fonarow G, Peterson E, Schwamm L, Xian Y, Wang Y. Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial. JAMA 2018, 320: 245-254. PMID: 29959443, DOI: 10.1001/jama.2018.8802.Peer-Reviewed Original ResearchConceptsMultifaceted quality improvement interventionAcute ischemic strokeQuality improvement interventionsEvidence-based performance measuresIschemic strokeImprovement interventionsControl groupUsual careClinical trialsIntervention groupEvidence-based stroke careCluster-randomized clinical trialClinical vascular eventsCo-primary outcomesLong-term outcomesHospital mortalityStroke RegistryVascular eventsSecondary outcomesPrimary outcomeStroke careCare protocolsClinical pathwayMAIN OUTCOMEPatientsComparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States
Man S, Zhao X, Uchino K, Hussain M, Smith E, Bhatt D, Xian Y, Schwamm L, Shah S, Khan Y, Fonarow G. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004512. PMID: 29794035, PMCID: PMC5978771, DOI: 10.1161/circoutcomes.117.004512.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCertificationComprehensive Health CareDelivery of Health Care, IntegratedEmergency Service, HospitalEndovascular ProceduresFemaleHospital MortalityHospitalsHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient TransferQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsPrimary stroke centerEmergency department admissionsStroke center certificationAcute ischemic strokeIschemic stroke careStroke centersStroke careDepartment admissionsHospital mortalityHospital outcomesIntravenous tPAIschemic strokeCenter certificationTPA timeComprehensive Stroke Center (CSC) certificationAcute ischemic stroke careMultivariable logistic regression modelAcute reperfusion therapyAcute stroke triageBrain Attack CoalitionDefect-free careComprehensive stroke centerOverall care qualityLogistic regression modelsGuidelines-StrokeAbsence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes
Gonzalez‐Castellon M, Ju C, Xian Y, Hernandez A, Fonarow G, Schwamm L, Smith E, Bhatt D, Reeves M, Willey J. Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes. Journal Of The American Heart Association 2018, 7: e007685. PMID: 29386207, PMCID: PMC5850252, DOI: 10.1161/jaha.117.007685.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaClinical CompetenceFemaleHealth StatusHospitals, TeachingHumansInternship and ResidencyMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient DischargePersonnel Staffing and SchedulingQuality Indicators, Health CareRegistriesStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsGuidelines-Stroke programProportion of patientsAcute ischemic strokeIschemic strokeJuly phenomenonHospital outcomesAcute ischemic stroke care qualityMultivariable logistic regression modelCare qualityDefect-free careStroke care qualityStroke performance measuresSymptomatic intracranial hemorrhageHours of admissionLower care qualityLogistic regression modelsNeedle timeIntracranial hemorrhageMultivariable analysisAdverse outcomesNonteaching hospitalsTomography timePatientsClinical metricsHospital
2017
Is Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data?
Reeves M, Fonarow G, Xu H, Matsouaka R, Xian Y, Saver J, Schwamm L, Smith E. Is Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data? Circulation Cardiovascular Quality And Outcomes 2017, 10: e003748. PMID: 29021333, DOI: 10.1161/circoutcomes.117.003748.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleGuideline AdherenceHospice CareHospital MortalityHospitalsHumansMaleMedicarePatient DischargePractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareRisk AssessmentRisk FactorsStrokeTime FactorsUnited StatesConceptsRisk-standardized mortality ratesHospital mortalityOutlier hospitalsAcute ischemic stroke casesHospital risk-standardized mortality ratesMortality dataGWTG-Stroke hospitalsHospital stroke mortalityIschemic stroke patientsProportion of hospitalsIschemic stroke casesRisk score modelStroke mortality dataChance-corrected agreementComposite outcomeStroke patientsMean ageStroke casesStroke mortalityMedicare filesHospital levelMortality rateLower mortalityHospitalMortalityRegional 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 careOutcomesReadmissionThe American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care
Ormseth CH, Sheth KN, Saver JL, Fonarow GC, Schwamm LH. The American Heart Association’s Get With the Guidelines (GWTG)-Stroke development and impact on stroke care. Stroke And Vascular Neurology 2017, 2: 94. PMID: 28959497, PMCID: PMC5600018, DOI: 10.1136/svn-2017-000092.Peer-Reviewed Original ResearchConceptsStroke care deliveryAmerican Heart AssociationHeart AssociationCare deliveryEvidence-based careContinuous quality improvement initiativesQuality improvement initiativesInpatient outcomesStroke ProgramPatient characteristicsStroke outcomeStroke careStroke developmentVoluntary registryPatient outcomesHospital adherenceImprovement initiativesOutcomesCareGuidelinesAssociationGWTGDeliveryRegistryTimely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated
Sauser Zachrison K, Levine D, Fonarow G, Bhatt D, Cox M, Schulte P, Smith E, Suter R, Xian Y, Schwamm L. Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003148. PMID: 28283469, PMCID: PMC5369604, DOI: 10.1161/circoutcomes.116.003148.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngioplasty, Balloon, CoronaryDelivery of Health Care, IntegratedFemaleFibrinolytic AgentsHumansMaleMiddle AgedMyocardial ReperfusionOrganizational ObjectivesPatient Care TeamProspective StudiesQuality ImprovementQuality Indicators, Health CareRegistriesST Elevation Myocardial InfarctionStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorUnited StatesConceptsST-segment elevation myocardial infarctionAcute ischemic strokeDTN timeD2B timeTimely reperfusionMyocardial infarctionHospital CompareGuidelines-Coronary Artery DiseaseHospital performanceHierarchical linear regression modelingEligible patientsGuidelines-StrokeNeedle timeSTEMI patientsBalloon timeIschemic strokeArtery diseaseHospital proportionLinear regression modelingProspective studyHospital differencesAIS carePatientsCare processesSpearman's rank correlation coefficientImpact of an Expanded Hospital Recognition Program for Stroke Quality of Care
Heidenreich P, Zhao X, Hernandez A, Schwamm L, Smith E, Reeves M, Peterson E, Fonarow G. Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care. Journal Of The American Heart Association 2017, 6: e004278. PMID: 28110310, PMCID: PMC5523627, DOI: 10.1161/jaha.116.004278.Peer-Reviewed Original ResearchMeSH KeywordsAgedAwards and PrizesFemaleGuideline AdherenceHospitalsHumansMalePractice Guidelines as TopicQuality Indicators, Health CareQuality of Health CareStrokeUse of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice
Xian Y, Xu H, Lytle B, Blevins J, Peterson E, Hernandez A, Smith E, Saver J, Messé S, Paulsen M, Suter R, Reeves M, Jauch E, Schwamm L, Fonarow G. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003227. PMID: 28096207, DOI: 10.1161/circoutcomes.116.003227.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaCross-Sectional StudiesFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHumansInfusions, IntravenousPractice Guidelines as TopicQuality ImprovementQuality Indicators, Health CareStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeConceptsNational quality improvement initiativeGuidelines-Stroke hospitalsAcute ischemic strokeDTN timeIntravenous tPAIschemic strokeNeedle timeTissue-type plasminogen activator administrationMedian DTN timeIschemic stroke patientsEmergency medical services (EMS) providersQuality improvement initiativesTissue-type plasminogen activatorHospital arrivalSymptom onsetStroke patientsMedical service providersClinical practiceHospitalPatientsMost hospitalsPlasminogen activatorPhase IStrokeImprovement initiatives
2015
Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke
Lin C, Cox M, Olson D, Britz G, Constable M, Fonarow G, Schwamm L, Peterson E, Shah B. Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke. Journal Of The American Heart Association 2015, 4: e001298. PMID: 26201547, PMCID: PMC4608060, DOI: 10.1161/jaha.114.001298.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAttitude of Health PersonnelBrain IschemiaDelivery of Health CareDrug Administration ScheduleFemaleFibrinolytic AgentsGuideline AdherenceHealth Care SurveysHealth Knowledge, Attitudes, PracticeHumansMaleMiddle AgedPerceptionPractice Guidelines as TopicPractice Patterns, Physicians'Quality ImprovementQuality Indicators, Health CareRegistriesStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsTissue plasminogen activatorIntravenous tissue plasminogen activatorAcute ischemic strokeAcute stroke careMinutes of arrivalLow annual volumeEligible patientsGuidelines hospitalsTPA administrationIschemic strokeStroke outcomeStroke careThrombolytic therapySmall percentageUS hospitalsDifferent hospitalsHospitalPatientsPlasminogen activatorTelephone surveyOne-thirdAdministrationMinutesAnnual volumePercentage
2014
Reducing Door‐to‐Puncture Times for Intra‐Arterial Stroke Therapy: A Pilot Quality Improvement Project
Mehta B, Leslie‐Mazwi T, Chandra R, Bell D, Sun C, Hirsch J, Rabinov J, Rost N, Schwamm L, Goldstein J, Levine W, Gupta R, Yoo A. Reducing Door‐to‐Puncture Times for Intra‐Arterial Stroke Therapy: A Pilot Quality Improvement Project. Journal Of The American Heart Association 2014, 3: e000963. PMID: 25389281, PMCID: PMC4338685, DOI: 10.1161/jaha.114.000963.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnesthesia Department, HospitalCooperative BehaviorFemaleFibrinolytic AgentsHumansInfusions, Intra-ArterialInterdisciplinary CommunicationMaleMiddle AgedPatient Care TeamPilot ProjectsProcess Assessment, Health CareProgram EvaluationPuncturesQuality ImprovementQuality Indicators, Health CareRetrospective StudiesStrokeThrombectomyThrombolytic TherapyTime and Motion StudiesTime FactorsTime-to-TreatmentTreatment OutcomeWorkflowConceptsPilot quality improvement projectQuality improvement projectPuncture timeMedian doorStroke patientsAnterior circulation stroke patientsIntra-arterial stroke therapyHospital time delayPre-QI cohortCompletion of imagingImprovement projectGreater delayNeurointerventional suiteHospital delayProximal occlusionIndependent predictorsStroke therapyPatient evaluationQI measuresWorse outcomesTherapy leadTreatment decisionsAnesthesia teamPatient arrivalPatientsImpact of an Expanded Hospital Recognition Program for Heart Failure Quality of Care
Heidenreich P, Zhao X, Hernandez A, Yancy C, Schwamm L, Albert N, Fonarow G. Impact of an Expanded Hospital Recognition Program for Heart Failure Quality of Care. Journal Of The American Heart Association 2014, 3: e000950. PMID: 25208954, PMCID: PMC4323821, DOI: 10.1161/jaha.114.000950.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCardiology Service, HospitalChi-Square DistributionCombined Modality TherapyDelivery of Health CareFemaleGuideline AdherenceHeart FailureHumansLogistic ModelsMaleMiddle AgedOdds RatioPractice Guidelines as TopicPractice Patterns, Physicians'Process Assessment, Health CareProgram EvaluationQuality ImprovementQuality Indicators, Health CareTime FactorsTreatment OutcomeUnited StatesConceptsBaseline useGuidelines-Heart Failure programImplantable cardioverter-defibrillator (ICD) useHeart Failure QualityInfluenza vaccination ratesSignificant greater increaseQuality of careHospital-level performanceTime 6 monthsHeart failureVaccination ratesCare measuresDefibrillator useHospitalHospital recognitionQuality measuresGreater increaseRate of increaseCareAdditional recognition
2013
Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals.
Schwamm L, Ali S, Reeves M, Smith E, Saver J, Messe S, Bhatt D, Grau-Sepulveda M, Peterson E, Fonarow G. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals. Circulation Cardiovascular Quality And Outcomes 2013, 6: 543-9. PMID: 24046398, DOI: 10.1161/circoutcomes.111.000303.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAge FactorsAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaChi-Square DistributionFemaleFibrinolytic AgentsHospitalsHumansMaleMiddle AgedMultivariate AnalysisOdds RatioQuality Indicators, Health CareRegistriesRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsIschemic stroke patientsTPA useAIS patientsPatient characteristicsStroke patientsHospitalized acute ischemic stroke patientsIntravenous tissue plasminogen activator useTissue plasminogen activator useNonwhite race/ethnicityAdditional calendar yearGuidelines-Stroke hospitalsAmerican Heart AssociationRace/ethnicityAIS admissionsGuidelines-StrokeEligible patientsIntravenous thrombolysisIntravenous tPAMore patientsMultivariable analysisHeart AssociationMild strokeTPA timeUnivariate analysis