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
Influence of Hospital Characteristics on Hospital Transfer Destinations for Patients With Stroke
Zachrison K, Amati V, Schwamm L, Yan Z, Nielsen V, Christie A, Reeves M, Sauser J, Lomi A, Onnela J. Influence of Hospital Characteristics on Hospital Transfer Destinations for Patients With Stroke. Circulation Cardiovascular Quality And Outcomes 2022, 15: e008269. PMID: 35369714, DOI: 10.1161/circoutcomes.121.008269.Peer-Reviewed Original Research
2021
Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks
Zachrison K, Richard J, Wilcock A, Zubizaretta J, Schwamm L, Uscher-Pines L, Mehrotra A. Association of Hospital Telestroke Adoption With Changes in Initial Hospital Presentation and Transfers Among Patients With Stroke and Transient Ischemic Attacks. JAMA Network Open 2021, 4: e2126612. PMID: 34554236, PMCID: PMC8461501, DOI: 10.1001/jamanetworkopen.2021.26612.Peer-Reviewed Original ResearchConceptsHospital stroke volumeControl hospitalsStroke volumeStroke centersStroke symptomsStroke systemsCase mixTransient ischemic attack admissionsHospital pairsInitial hospital presentationThrombectomy-capable hospitalsComprehensive stroke centerTransient ischemic attackPrimary stroke centerCross-sectional studyMajor teaching hospitalObserved patient characteristicsBed sizeHospital presentationIschemic attackInitial hospitalCritical access hospitalsPatient characteristicsInterhospital transferPostimplementation periodCTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals
Yu A, Regenhardt R, Whitney C, Schwamm L, Patel A, Stapleton C, Viswanathan A, Hirsch J, Lev M, Leslie-Mazwi T. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. American Journal Of Neuroradiology 2021, 42: 435-440. PMID: 33541900, PMCID: PMC7959422, DOI: 10.3174/ajnr.a6950.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomySpoke hospitalsTelestroke networkHub hospitalCTA protocolHealth Stroke Scale scoreEmergent large vessel occlusionStroke Scale scoreRate of patientsLarge vessel occlusionCTA utilizationThrombectomy ratesStroke triageThrombectomyNonsignificant increasePatientsScale scoreHospitalTriage processNational InstituteOverall rateCTAExtended windowHigher numberRetention rate
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 dyadsResource utilisation among patients transferred for intracerebral haemorrhage
Zachrison K, Aaronson E, Mahmood S, Rosand J, Viswanathan A, Schwamm L, Goldstein J. Resource utilisation among patients transferred for intracerebral haemorrhage. Stroke And Vascular Neurology 2019, 4: 223. PMID: 32030206, PMCID: PMC6979870, DOI: 10.1136/svn-2019-000255.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAge FactorsAgedAged, 80 and overCerebral HemorrhageCritical CareFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedNeurosurgical ProceduresPatient AdmissionPatient TransferProspective StudiesRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsGlasgow Coma ScoreIntracerebral hemorrhageSurgical interventionICH scoreAcademic hospitalBaseline Glasgow Coma ScoreIntensive care unit admissionCare unit admissionSingle academic hospitalPrimary intracerebral hemorrhageUrban academic hospitalLess frequent useCollected registryICU stayUnit admissionComa ScoreConsecutive patientsIntraventricular hemorrhagePrimary outcomePrimary patientsPatientsHospitalLogistic regressionHemorrhageResource utilisationA 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 ResearchUse, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States
Shah S, Xian Y, Sheng S, Zachrison KS, Saver JL, Sheth KN, Fonarow GC, Schwamm LH, Smith EE. Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States. Circulation 2019, 139: 1568-1577. PMID: 30700144, PMCID: PMC6816244, DOI: 10.1161/circulationaha.118.036509.Peer-Reviewed Original ResearchConceptsEndovascular therapyInterhospital transferHospital outcomesIschemic strokeMultivariable logistic regression modelSymptomatic intracranial hemorrhageAcute ischemic strokeComprehensive stroke centerLarge vessel occlusionRisk-adjusted modelsLogistic regression modelsEVT outcomesGuidelines-StrokeHospital mortalityStroke centersIndependent ambulationPivotal trialsStroke careIntracranial hemorrhageVessel occlusionEVT casesStroke systemsWhite racePatientsFurther evaluation
2018
Ischemic Stroke Transfer Patterns in the Northeast United States
Zachrison K, Onnela J, Hernandez A, Reeves M, Camargo C, Cox M, Matsouaka R, Metlay J, Goldstein J, Schwamm L. Ischemic Stroke Transfer Patterns in the Northeast United States. Journal Of Stroke And Cerebrovascular Diseases 2018, 28: 295-304. PMID: 30389376, DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.048.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke registryRegional stroke systemIschemic stroke patientsHospital connectionsTissue plasminogen activatorSevere strokeMore patientsStroke patientsIS patientsReceiving HospitalPatient dischargeStroke systemsPatient transferPatientsHospitalNortheast hospitalsMost hospitalsPlasminogen activatorCareUnited StatesFurther characterizationAdmissionRegistryStrokeEvaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network
Gadhia R, Schwamm L, Viswanathan A, Whitney C, Moreno A, Zachrison K. Evaluation of the Experience of Spoke Hospitals in an Academic Telestroke Network. Telemedicine Journal And E-Health 2018, 25: 584-590. PMID: 30256724, DOI: 10.1089/tmj.2018.0133.Peer-Reviewed Original ResearchRates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care
Ali S, Fonarow G, Liang L, Xian Y, Smith E, Bhatt D, Schwamm L. Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care. Circulation Cardiovascular Quality And Outcomes 2018, 11: e003359. PMID: 30354551, DOI: 10.1161/circoutcomes.116.003359.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCentralized Hospital ServicesDisability EvaluationFemaleHealthcare DisparitiesHospital MortalityHumansMaleMiddle AgedPatient AdmissionPatient TransferRecovery of FunctionRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsSpecialized stroke centersStroke centersHospital mortalityAIS casesPrevious stroke/transient ischemic attackStroke/transient ischemic attackHealth Stroke Scale scoreHigher median National InstitutesWorse short-term outcomesAcute ischemic stroke careGuidelines-Stroke registryMedian National InstitutesOutcomes of patientsStroke Scale scoreTransient ischemic attackShort-term outcomesIschemic stroke careTransfer of patientsMidwest teaching hospitalInstitutional mortality ratesIschemic attackMultivariable adjustmentBaseline characteristicsRankin ScaleClinical outcomesComparison 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-StrokeDelays in the Air or Ground Transfer of Patients for Endovascular Thrombectomy
Regenhardt RW, Mecca AP, Flavin SA, Boulouis G, Lauer A, Zachrison KS, Boomhower J, Patel AB, Hirsch JA, Schwamm LH, Leslie-Mazwi TM. Delays in the Air or Ground Transfer of Patients for Endovascular Thrombectomy. Stroke 2018, 49: 1419-1425. PMID: 29712881, PMCID: PMC5970980, DOI: 10.1161/strokeaha.118.020618.Peer-Reviewed Original ResearchConceptsEndovascular therapySpoke hospitalsTelestroke networkUnderwent endovascular therapyEndovascular thrombectomyHealth StrokeIschemic strokeClinical outcomesMedian delayHub hospitalInclusion criteriaTelestroke consultsMultivariable regressionTreatment opportunitiesPossible predictorsTreatment ratesPatientsHospitalDaytime transfersLong transfer timesNational Institute
2017
Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy
Boulouis G, Lauer A, Siddiqui A, Charidimou A, Regenhardt R, Viswanathan A, Rost N, Leslie-Mazwi T, Schwamm L. Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy. JAMA Neurology 2017, 74: 1361-1367. PMID: 28973081, PMCID: PMC5710581, DOI: 10.1001/jamaneurol.2017.2149.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersCollateral blood flowIschemic strokeInfarct progressionMechanical thrombectomyCT angiographyMAIN OUTCOMEVessel statusBlood flowImaging factorsHigher adjusted odds ratioVascular imagingFavorable imaging profileHealth Stroke ScoreAcute ischemic strokeHigher National InstitutesAdjusted odds ratioRegional stroke networkStroke care networksStroke centersStroke ScoreConsecutive patientsStroke NetworkClinical severityFutile transfers
2015
Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke
Sheth KN, Smith EE, Grau-Sepulveda MV, Kleindorfer D, Fonarow GC, Schwamm LH. Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke. Stroke 2015, 46: 732-739. PMID: 25672784, DOI: 10.1161/strokeaha.114.007506.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorSymptomatic intracranial hemorrhageTPA useAcute strokeIschemic strokeIntracranial hemorrhageHealth Stroke Scale scoreReal-world practice patternsGuidelines-Stroke programStroke Scale scoreAcute ischemic strokeCharacteristics of patientsLower National InstitutesPatient selection biasConventional thrombolysisHospital mortalityHospital outcomesSymptom onsetInterhospital transferThrombolytic therapyHospital characteristicsPractice patternsShip paradigmMAIN OUTCOME
2013
Characteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care
Ali S, Singhal A, Viswanathan A, Rost N, Schwamm L. Characteristics and Outcomes Among Patients Transferred to a Regional Comprehensive Stroke Center for Tertiary Care. Stroke 2013, 44: 3148-3153. PMID: 24021682, DOI: 10.1161/strokeaha.113.002493.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous tissue plasminogen activatorInitial National InstitutesComprehensive stroke centerHospital mortalityIschemic strokeTissue plasminogen activatorStroke centersStroke careDoor patientsHealth Stroke Scale scoreMedian initial National InstitutesAcute ischemic stroke carePlasminogen activatorLonger hospital lengthStroke care centerHealth Stroke ScaleStroke Scale scoreCoronary artery diseaseIschemic stroke careAcute care hospitalsNational InstituteHospital lengthSevere strokeStroke Registry
2009
Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe
Pervez M, Silva G, Masrur S, Betensky R, Furie K, Hidalgo R, Lima F, Rosenthal E, Rost N, Viswanathan A, Schwamm L. Remote Supervision of IV-tPA for Acute Ischemic Stroke by Telemedicine or Telephone Before Transfer to a Regional Stroke Center Is Feasible and Safe. Stroke 2009, 41: e18-e24. PMID: 19910552, PMCID: PMC3383769, DOI: 10.1161/strokeaha.109.560169.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overBrain IschemiaFeasibility StudiesFemaleFollow-Up StudiesHospitalizationHumansInfusions, IntravenousMaleMiddle AgedPatient TransferProspective StudiesRemote ConsultationRetrospective StudiesStrokeTelemedicineTelephoneTime FactorsTissue Plasminogen ActivatorYoung AdultConceptsTissue plasminogen activatorOSH patientsCatheter-based reperfusionGuidelines-Stroke databaseAcute ischemic strokeOutcomes of patientsRegional stroke centerDischarge functional statusRSC patientsTelestroke patientsIntravenous thrombolysisIschemic strokeIV-tPARankin scoreSevere strokeStroke centersSymptom onsetTPA infusionRetrospective reviewStroke databaseStroke specialistsFunctional outcomeFunctional statusTelephone consultationsSystemic hemorrhage
2002
T HE E VOLVING R OLE OF H ELICOPTER E MERGENCY M EDICAL S ERVICES IN THE T RANSFER OF S TROKE P ATIENTS TO S PECIALIZED C ENTERS
Thomas S, Kociszewski C, Schwamm L, Wedel S. T HE E VOLVING R OLE OF H ELICOPTER E MERGENCY M EDICAL S ERVICES IN THE T RANSFER OF S TROKE P ATIENTS TO S PECIALIZED C ENTERS. Prehospital Emergency Care 2002, 6: 210-214. PMID: 11962569, DOI: 10.1080/10903120290938562.Peer-Reviewed Original ResearchConceptsHospital arrivalERA patientsIschemic strokeThrombolysis eraSymptom onsetThrombolytic therapyInterfacility transportHEMS activationHelicopter emergency medical services (HEMS) programsE MERGENCY M EDICAL S ERVICESHospital requestsLogistic regression analysisHelicopter EMS (HEMS) transportEmergency medical services programPearson chi-squarePatient demographicsHEMS transportRetrospective studyStroke patientsInterfacility transferP atientsEMS transportHelicopter transportPatientsDrug Administration