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 doorAssociation Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke
Man S, Xian Y, Holmes D, Matsouaka R, Saver J, Smith E, Bhatt D, Schwamm L, Fonarow G. Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA 2020, 323: 2170-2184. PMID: 32484532, PMCID: PMC7267850, DOI: 10.1001/jama.2020.5697.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorAcute ischemic strokeTissue plasminogen activatorCause mortalityNeedle timeCause readmissionIschemic strokeLong-term outcomesShorter doorBetter long-term outcomesImproved long-term outcomesPlasminogen activatorRetrospective cohort studyGood functional outcomeGuidelines-StrokeCohort studyHospital arrivalHospital dischargeMedian doorEarly administrationMedian agePrimary outcomeThrombolytic therapyFunctional outcomeReadmission
2019
The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study
Kaufman B, O’Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Song P, Schwamm L, Smith E, Fonarow G, Xian Y. The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study. Journal Of General Internal Medicine 2019, 34: 2740-2748. PMID: 31452032, PMCID: PMC6854149, DOI: 10.1007/s11606-019-05283-1.Peer-Reviewed Original ResearchConceptsAccountable care organizationsIschemic strokeRecurrent strokeMSSP accountable care organizationsIndex hospital stayIncident ischemic strokeRetrospective cohort studyAcute care utilizationIschemic stroke patientsMedicare Shared Savings Program Accountable Care OrganizationsModerate ischemic strokeConclusionsAmong patientsMain MeasuresOutcomesCause readmissionHospital stayCohort studyHome dischargeCare utilizationStroke patientsTransitional careProbability of dischargeCare coordinationPatient outcomesMedicare claimsService beneficiaries
2018
Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission
El Husseini N, Fonarow G, Smith E, Ju C, Sheng S, Schwamm L, Hernandez A, Schulte P, Xian Y, Goldstein L. Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission. Stroke 2018, 49: 2896-2903. PMID: 30571413, PMCID: PMC6338440, DOI: 10.1161/strokeaha.118.022011.Peer-Reviewed Original ResearchConceptsPoststroke mortalityIschemic strokeDialysis statusHospital readmissionKidney functionPoststroke outcomesMultivariable Cox proportional hazards modelsCox proportional hazards modelService Medicare patientsGlomerular filtration rateHospital readmission ratesRisk stratification modelProportional hazards modelEGFR 15Guidelines-StrokeIndex hospitalizationPostdischarge mortalityEGFR 30EGFR 45Readmission ratesRehospitalization ratesCohort studyKidney diseaseFiltration rateIndependent association
2017
Regional 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
2015
Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient‐Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study
O'Brien E, Greiner M, Xian Y, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Maisch L, Hannah D, Lindholm B, Peterson E, Pencina M, Hernandez A. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient‐Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation 2015, 132: 1404-1413. PMID: 26246175, DOI: 10.1161/circulationaha.115.016183.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCardiovascular DiseasesDose-Response Relationship, DrugFemaleFollow-Up StudiesHospitalizationHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMedicaidMedical RecordsMedicarePatient DischargePatient Outcome AssessmentPatient ReadmissionRecurrenceRegistriesTreatment OutcomeUnited StatesConceptsMajor adverse cardiovascular eventsAdverse cardiovascular eventsStatin therapyTime of admissionCardiovascular eventsIschemic strokePatient prefersCause mortalityHemorrhagic strokeOlder ischemic stroke patientsGuidelines-Stroke registryHigh-intensity doseIschemic stroke patientsModerate-intensity statinsPatient-centered outcomesReal-world effectivenessYears of ageOutcomes Research InstituteEffectiveness researchCoprimary outcomesCardiovascular readmissionCause readmissionSecondary outcomesStroke patientsClinical effectiveness
2013
Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke
Qian F, Fonarow G, Smith E, Xian Y, Pan W, Hannan E, Shaw B, Glance L, Peterson E, Eapen Z, Hernandez A, Schwamm L, Bhatt D. Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2013, 6: 284-292. PMID: 23680966, DOI: 10.1161/circoutcomes.113.000211.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overBlack or African AmericanBrain IschemiaEthnicityFemaleHealth Status DisparitiesHealthcare DisparitiesHispanic or LatinoHumansLogistic ModelsMaleMedicareMultivariate AnalysisOdds RatioPatient ReadmissionRacial GroupsRegistriesRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeLong-term outcomesRace/ethnicityCause rehospitalizationOlder patientsIschemic strokeUnadjusted mortalityHispanic patientsGuidelines-Stroke programGuidelines-Stroke registryHealth Stroke ScaleOlder Medicare beneficiariesAmerican Heart AssociationAsian American patientsYears of ageStroke ScaleStroke severityHigher median scoresAsian patientsHeart AssociationHospital characteristicsAmerican patientsUS CentersPrognostic variablesLower odds
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
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