2023
Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke
Wang C, Gu H, Zong L, Zhang X, Zhou Q, Jiang Y, Li H, Meng X, Yang X, Wang M, Huo X, Wangqin R, Bei Y, Qi X, Liu X, Hu S, Wang Z, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y, Li Z, Yang Q, Chen G, Ma Q, Li X, Chen J, Zhao X, Wang H, Niu X, Xu J, Zhao L, Wang Z, Huang D, Jin X, Chen S, Li J, Yu J, Liu P, Li G, Hao Y, Yang G, Huang X, Zhou C, Yang J, Gu J, Sun P, Guo Z, Ma G, Chen G, Tang M, Wang N, Chen L, Li J, Li A, Li S, Cao M, Guo J, Ren Y, Li T, Zhang L, Xie Z, Dong J, Kong X, Liang H, Zhang Y. Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke. JAMA Network Open 2023, 6: e2316465. PMID: 37266940, PMCID: PMC10238948, DOI: 10.1001/jamanetworkopen.2023.16465.Peer-Reviewed Original ResearchMeSH KeywordsAgedHumansIschemic StrokeMaleQuality ImprovementReperfusionStrokeTissue Plasminogen ActivatorConceptsAcute ischemic strokeQuality improvement interventionsTargeted quality improvement interventionsReperfusion therapy ratesProportion of patientsIschemic strokeEligible patientsStepped-wedge clusterSymptom onsetReperfusion therapyEndovascular thrombectomyImprovement interventionsTherapy ratesUsual careSecondary outcomesPrimary outcomeSecondary hospitalsClinical trialsIntravenous recombinant tissue plasminogen activatorModified Rankin Scale scoreRecombinant tissue plasminogen activatorRankin Scale scoreTissue plasminogen activatorEVT rateHospital mortality
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 startNational 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 emergencyClinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China
Gu H, Yang X, Wang C, Zhao X, Wang Y, Liu L, Meng X, Jiang Y, Li H, Liu C, Wangqin R, Fonarow G, Schwamm L, Xian Y, Li Z, Wang Y. Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China. JAMA Network Open 2021, 4: e2120745. PMID: 34387677, PMCID: PMC8363916, DOI: 10.1001/jamanetworkopen.2021.20745.Peer-Reviewed Original ResearchMeSH KeywordsAgedChinaFemaleHospital MortalityHumansIschemic Attack, TransientMaleQuality ImprovementStrokeConceptsTransient ischemic attackChinese Stroke Center AllianceMajor adverse cardiovascular eventsHospital clinical outcomesQuality improvement studyIschemic strokeIntracerebral hemorrhageIschemic attackClinical characteristicsClinical outcomesPoor outcomeIntravenous recombinant tissue plasminogen activatorTemporal improvementRecombinant tissue plasminogen activatorAdverse cardiovascular eventsIn-Hospital OutcomesUse of anticoagulantsComposite scoreImprovement studyTissue plasminogen activatorMean composite scoreHealth care systemHospital complicationsTIA admissionsTIA careAcute Ischemic Stroke in Patients With COVID-19
Srivastava P, Zhang S, Xian Y, Xu H, Rutan C, Alger H, Walchok J, Williams J, de Lemos J, Decker-Palmer M, Alhanti B, Elkind M, Messé S, Smith E, Schwamm L, Fonarow G. Acute Ischemic Stroke in Patients With COVID-19. Stroke 2021, 52: 1826-1829. PMID: 33728926, DOI: 10.1161/strokeaha.121.034301.Peer-Reviewed Original Research
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 ConsultationStrokeTelemedicineWorkflowPatient reported outcome measures (PROMs) in amyotrophic lateral sclerosis
De Marchi F, Berry J, Chan J, Caldwell S, Ellrodt A, Scalia J, Burke K, Fang T, Clark Sisodia R, Schwamm L, Moura L, Paganoni S. Patient reported outcome measures (PROMs) in amyotrophic lateral sclerosis. Journal Of Neurology 2020, 267: 1754-1759. PMID: 32125520, DOI: 10.1007/s00415-020-09774-8.Peer-Reviewed Original ResearchConceptsOutcome measuresClinical careALS Functional RatingMental health subscoresALSFRS-R scoreOutpatient clinic visitsOutcomes Measurement Information SystemClinical outcome measuresRoutine clinical careMental health scoresAmyotrophic lateral sclerosisMeasurement Information SystemQuality of lifeTablet-based surveyALS careALS clinicClinic visitsPROM scoresFunctional ratingClinic staffHealth scoresLateral sclerosisPROM collectionPatientsPhysical health
2019
A 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 practiceParticipation 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 evaluationHospitalInternational Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program
Wangqin R, Laskowitz D, Wang Y, Li Z, Wang Y, Liu L, Liang L, Matsouaka R, Saver J, Fonarow G, Bhatt D, Smith E, Schwamm L, Bettger J, Hernandez A, Peterson E, Xian Y. International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program. Journal Of The American Heart Association 2018, 7: e010623. PMID: 30371291, PMCID: PMC6474951, DOI: 10.1161/jaha.118.010623.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryNational Stroke RegistryAcute ischemic strokeStroke RegistryIschemic strokeChinese patientsDeep venous thrombosis prophylaxisHealth Stroke ScaleVenous thrombosis prophylaxisAcute stroke careAdministration of thrombolyticsEvidence-based guidelinesAmerican Heart AssociationQuality of careBackground AdherenceDischarge antithromboticsThrombosis prophylaxisCessation counselingStroke ProgramStroke ScaleClinical characteristicsHospital arrivalNeedle timePatient characteristicsSecondary preventionEffect 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-Stroke
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 mortalityHospitalMortalityThe 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 coefficientUse 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
2016
Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic
Moura L, Schwamm E, Moura Junior V, Seitz M, Hsu J, Cole A, Schwamm L. Feasibility of the collection of patient-reported outcomes in an ambulatory neurology clinic. Neurology 2016, 87: 2435-2442. PMID: 27815405, PMCID: PMC5177682, DOI: 10.1212/wnl.0000000000003409.Peer-Reviewed Original ResearchConceptsPatient-reported outcome measuresT-scoreNeurology clinicAmbulatory neurology clinicMental health T-scoresGeneral neurology clinicPatient-reported outcomesMental health scoresUS general populationQuality of lifeMental health assessmentMean T-scoreQOLIE-10Rankin ScaleNeurology patientsEpilepsy scoresClinical dataOutcome measuresHealth scoresAdministrative claimsGeneral populationPatientsStudy periodVulnerable populationsDemographic characteristics