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 proportionDepartmentAssociationVariation in patterns of telestroke usage during the COVID-19 pandemic
Nakamoto C, Wilcock A, Schwamm L, Zachrison K, Uscher-Pines L, Mehrotra A. Variation in patterns of telestroke usage during the COVID-19 pandemic. Journal Of Stroke And Cerebrovascular Diseases 2023, 32: 107036. PMID: 36791674, PMCID: PMC9899774, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107036.Peer-Reviewed Original Research
2022
Financial impact of telehealth: rural chief financial officer perspectives.
Uscher-Pines L, Sousa J, Zachrison K, Schwamm L, Mehrotra A. Financial impact of telehealth: rural chief financial officer perspectives. The American Journal Of Managed Care 2022, 28: e436-e443. PMID: 36525663, PMCID: PMC10074395, DOI: 10.37765/ajmc.2022.89279.Peer-Reviewed Original ResearchConceptsTelehealth servicesShort-term acute care hospitalsAcute care hospitalsAddress patients' needsHospital administratorsQuality of careCritical access hospitalsCare hospitalPerson careLimited reimbursementPatient needsTelehealth utilizationRural hospitalsTelehealth programHospitalTelehealthAccess hospitalsHospital AssociationSpoke‐Administered Thrombolysis Improves Large‐Vessel Occlusion Early Recanalization: The Real‐World Experience of a Large Academic Hub‐and‐Spoke Telestroke Network
Kraft A, Regenhardt R, Awad A, Rosenthal J, Dmytriw A, Vranic J, Bonkhoff A, Bretzner M, Hirsch J, Rabinov J, Stapleton C, Schwamm L, Singhal A, Rost N, Leslie‐Mazwi T, Patel A. Spoke‐Administered Thrombolysis Improves Large‐Vessel Occlusion Early Recanalization: The Real‐World Experience of a Large Academic Hub‐and‐Spoke Telestroke Network. Stroke Vascular And Interventional Neurology 2022, 3 PMID: 36816048, PMCID: PMC9936963, DOI: 10.1161/svin.122.000427.Peer-Reviewed Original ResearchIntravenous thrombolysisMechanical thrombectomyEarly recanalizationInterhospital transferLarge vessel occlusion strokeLack of efficacyReal-world analysisVessel imagingEligible patientsMedian ageOcclusion strokeRecent trialsStroke NetworkTelestroke networkInclusion criteriaPatientsIVT useReal-world experienceNIHSSThrombolysisRecanalizationHospitalLVOImagingER ratesTemporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey
Wang C, Gu H, Zhang X, Jiang Y, Li H, Bettger J, Meng X, Dong K, Wangqin R, Yang X, Wang M, Liu C, Liu L, Tang B, Li G, Xu Y, He Z, Yang Y, Yip W, Fonarow G, Schwamm L, Xian Y, Zhao X, Wang Y, Wang Y, Li Z. Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey. Stroke And Vascular Neurology 2022, 8: 34-50. PMID: 35985768, PMCID: PMC9985802, DOI: 10.1136/svn-2022-001552.Peer-Reviewed Original ResearchConceptsCerebrovascular risk factorsHospital mortalityIschemic strokeRisk factorsComposite outcomeRural-urban disparitiesUrban hospitalHospital managementSecondary prevention treatmentSerial cross-sectional surveysHospital admission ratesIschemic stroke admissionsTwo-stage random sampling surveyCause of mortalityCross-sectional surveyHospital outcomesStroke admissionsCurrent smokingHospital admissionHospital burdenAdmission ratesMedical advicePrevention treatmentTemporal improvementHospitalTrends in characteristics of neurologists who provide stroke consultations in the USA, 2008–2021
Nakamoto C, Wilcock A, Schwamm L, Majersik J, Zachrison K, Mehrotra A. Trends in characteristics of neurologists who provide stroke consultations in the USA, 2008–2021. Stroke And Vascular Neurology 2022, 8: 86-88. PMID: 35902139, PMCID: PMC9985800, DOI: 10.1136/svn-2022-001662.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTransient ischemic attackVascular neurologistsPatient's homeAIS/transient ischemic attackHigh-volume providersNeurologist consultationTIA episodesIschemic attackIschemic strokeStroke consultationsNeurologistsService MedicarePhysician practicesStudy periodConsultsPatientsEpisodesConsultationHomeHospitalStrokeProportionIschemic Stroke Systems of Care in California: Evolution in the Organization During the Mechanical Thrombectomy Era
Zachrison K, Hsia R, Li S, Reeves M, Camargo C, Yan Z, Onnela J, Schwamm L. Ischemic Stroke Systems of Care in California: Evolution in the Organization During the Mechanical Thrombectomy Era. Stroke Vascular And Interventional Neurology 2022, 2 DOI: 10.1161/svin.121.000206.Peer-Reviewed Original ResearchEndovascular thrombectomyStroke systemsHospital-level factorsOdds of transferLogistic regression modelsAlteplase useEVT proceduresStroke NetworkObservational studyTimely careRural hospitalsTrial dataHospitalPatientsHospital postsHospital pairsCarePatient transfer networksRegression modelsNumber of encountersLinear regressionThrombectomyAlteplaseRegressionGreater POSTImproving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit
Richard J, Mehrotra A, Schwamm L, Wilcock A, Uscher‐Pines L, Majersik J, Zachrison K. Improving Population Access to Stroke Expertise Via Telestroke: Hospitals to Target and the Potential Clinical Benefit. Journal Of The American Heart Association 2022, 11: e025559. PMID: 35435016, PMCID: PMC9238444, DOI: 10.1161/jaha.122.025559.Peer-Reviewed Original ResearchIn a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes
Kraft A, Awad A, Rosenthal J, Dmytriw A, Vranic J, Bonkhoff A, Bretzner M, Hirsch J, Rabinov J, Stapleton C, Schwamm L, Rost N, Leslie-Mazwi T, Patel A, Regenhardt R. In a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes. Interventional Neuroradiology 2022, 29: 315-320. PMID: 35317663, PMCID: PMC10369105, DOI: 10.1177/15910199221087498.Peer-Reviewed Original ResearchConceptsLarge vessel occlusion strokeIntravenous thrombolysisIVT-treated patientsMechanical thrombectomyProcedure timePuncture timeImproved reperfusionBaseline characteristicsTICI 2bIVT patientsOcclusion strokeOperative reportsProcedural characteristicsTelestroke networkPatientsReperfusionIncreased proportionThrombolysisTechnical difficultiesNIHSSThrombectomyHospitalStrokeMin
2021
Reperfusion 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 patternsCTA 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
2020
Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States.
Prabhakaran S, Messé S, Kleindorfer D, Smith E, Fonarow G, Xu H, Zhao X, Lytle B, Cigarroa J, Schwamm L. Cryptogenic stroke: Contemporary trends, treatments, and outcomes in the United States. Neurology Clinical Practice 2020, 10: 396-405. PMID: 33299667, PMCID: PMC7717635, DOI: 10.1212/cpj.0000000000000736.Peer-Reviewed Original ResearchCryptogenic strokeIschemic strokeStroke etiologyDischarge outcomesHospital treatmentHospital characteristicsMultivariable logistic regressionGWTG-StrokeStroke RegistryNationwide registryMultivariable analysisPatientsLower mortalityHigh mortalityNationwide dataLogistic regressionSubtypesStrokeNational InstituteScale scaleOutcomesTreatmentRegistryHospitalEtiologyAssessment of Telestroke Capacity in US Hospitals
Richard J, Wilcock A, Schwamm L, Uscher-Pines L, Zachrison K, Siddiqui A, Mehrotra A. Assessment of Telestroke Capacity in US Hospitals. JAMA Neurology 2020, 77: 1035-1037. PMID: 32453424, PMCID: PMC7251500, DOI: 10.1001/jamaneurol.2020.1274.Peer-Reviewed Original ResearchEstablishment of an internationally agreed minimum data set for acute telestroke
Cadilhac D, Bagot K, Demaerschalk B, Hubert G, Schwamm L, Watkins C, Lightbody C, Kim J, Vu M, Pompeani N, Switzer J, Caudill J, Estrada J, Viswanathan A, Hubert N, Ohannessian R, Hargroves D, Roberts N, Ingall T, Hess D, Ranta A, Padma V, Bladin C. Establishment of an internationally agreed minimum data set for acute telestroke. Journal Of Telemedicine And Telecare 2020, 27: 582-589. PMID: 31937198, DOI: 10.1177/1357633x19899262.Peer-Reviewed Original ResearchConceptsTelestroke programsMinimum datasetExpert panelProcess of careGeneral clinical careInternational expert panelReliable international comparisonsTelestroke consultationThrombolysis treatmentPatient characteristicsEndovascular treatmentAcute careClinical managementPatient outcomesClinical careNeurosurgery treatmentDischarge informationInitial scoping reviewCareScoping ReviewTelestrokeHospitalTreatmentAustralasia-Pacific regionDelphi technique
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 dyadsStroke Center Certification and Performance: A Longitudinal Analysis of the Northeast Cerebrovascular Consortium Region.
Wira CR, Melluzzo S, Beasley TM, Magdon-Ismail Z, Day D, Madsen TE, McCullough LD, Stein J, Schwamm LH, Gropen T. Stroke Center Certification and Performance: A Longitudinal Analysis of the Northeast Cerebrovascular Consortium Region. The Yale Journal Of Biology And Medicine 2019, 92: 587-596. PMID: 31866774, PMCID: PMC6913814.Peer-Reviewed Original ResearchResource 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 utilisationPatient and clinician experiences with telehealth for patient follow-up care.
Donelan K, Barreto E, Sossong S, Michael C, Estrada J, Cohen A, Wozniak J, Schwamm L. Patient and clinician experiences with telehealth for patient follow-up care. The American Journal Of Managed Care 2019, 25: 40-44. PMID: 30667610.Peer-Reviewed Original Research
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 evaluationHospitalIschemic 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 characterizationAdmissionRegistryStroke