2024
Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program
Xian Y, Li S, Jiang T, Beon C, Poudel R, Thomas K, Reeves M, Smith E, Saver J, Sheth K, Messé S, Schwamm L, Fonarow G. Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program. Stroke 2024, 55: 2599-2610. PMID: 39429153, PMCID: PMC11518659, DOI: 10.1161/strokeaha.124.048174.Peer-Reviewed Original ResearchConceptsGuidelines-Stroke programEvidence-based stroke careDoor-to-needle timeTransient ischemic attackGuidelines-Stroke hospitalsEvidence-based careQuality of careSmoking cessation counselingSustained improvementQuality improvement initiativesSkilled nursing facilityIndependence of patientsAcute ischemic strokeIschemic strokeRelevant to patientsIschemic attackDoor-to-puncture timeCessation counselingGuidelines-StrokeAssociated with sustained improvementStroke careDysphagia screeningNursing facilitiesHospital characteristicsImprovement initiatives
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 start
2020
Acute ischemic stroke: improving access to intravenous tissue plasminogen activator
Turner A, Schwamm L, Etherton M. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Review Of Cardiovascular Therapy 2020, 18: 277-287. PMID: 32323590, DOI: 10.1080/14779072.2020.1759422.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsIschemic strokeStroke patientsTreatment windowAcute ischemic stroke patientsIntravenous tissue plasminogen activatorTreatment ratesUnknown symptom onsetAcute stroke careTissue plasminogen activatorQuality improvement initiativesHealth care resourcesUnited States FoodStroke outcomeSymptom onsetStroke careStroke specialistsStroke systemsTelestroke networkDrug AdministrationAlteplasePatientsPlasminogen activatorStates Food
2017
The 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 initiativesOutcomesCareGuidelinesAssociationGWTGDeliveryRegistryUse 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
2014
Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative
Fonarow G, Zhao X, Smith E, Saver J, Reeves M, Bhatt D, Xian Y, Hernandez A, Peterson E, Schwamm L. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA 2014, 311: 1632-1640. PMID: 24756513, DOI: 10.1001/jama.2014.3203.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaDecision Support Systems, ClinicalFemaleFibrinolytic AgentsGuideline AdherenceHospital MortalityHospitalsHumansIntracranial HemorrhagesMaleMiddle AgedPatient DischargeQuality ImprovementRegistriesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeConceptsAcute ischemic strokeQuality improvement initiativesTissue plasminogen activatorNational quality improvement initiativeSymptomatic intracranial hemorrhageDTN timeTPA administrationIntracranial hemorrhagePostintervention periodIschemic strokeNeedle timeClinical outcomesPreintervention periodImprovement initiativesHospital risk-adjusted mortalityIntravenous tissue plasminogen activatorTissue plasminogen activator administrationMedian DTN timePercentage of patientsProportion of patientsClinical decision support toolRisk-adjusted mortalityGuidelines-StrokeHospital mortalityYear preintervention
2012
Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program
Rost N, Smith E, Pervez M, Mello P, Dreyer P, Schwamm L. Predictors of Increased Intravenous Tissue Plasminogen Activator Use Among Hospitals Participating in the Massachusetts Primary Stroke Service Program. Circulation Cardiovascular Quality And Outcomes 2012, 5: 314-320. PMID: 22534407, PMCID: PMC3361890, DOI: 10.1161/circoutcomes.111.962829.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedAged, 80 and overEmergency Service, HospitalFemaleFibrinolytic AgentsHealthcare DisparitiesHumansInfusions, IntravenousLinear ModelsLogistic ModelsMaleMassachusettsMiddle AgedMultivariate AnalysisOdds RatioPatient SelectionPractice Guidelines as TopicQuality ImprovementRegional Medical ProgramsRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntravenous tissue plasminogen activator useTissue plasminogen activator useAcute ischemic strokeTPA useIschemic strokeOlder acute ischemic stroke patientsAcute ischemic stroke patientsGuidelines-Stroke programStroke center designationIschemic stroke patientsRate of thrombolysisQuality improvement initiativesEmergency medical servicesStroke onsetSymptom onsetStroke patientsTreatment disparitiesCenter designationPatientsHospitalMassachusetts DepartmentImprovement initiativesMedical servicesOverall rateFurther studiesPredictors of Rapid Brain Imaging in Acute Stroke
Kelly A, Hellkamp A, Olson D, Smith E, Schwamm L. Predictors of Rapid Brain Imaging in Acute Stroke. Stroke 2012, 43: 1279-1284. PMID: 22442169, DOI: 10.1161/strokeaha.111.626374.Peer-Reviewed Original ResearchMeSH KeywordsAge FactorsAgedDiabetes MellitusEmergency Service, HospitalFemaleFibrinolytic AgentsGuideline AdherenceHumansMagnetic Resonance ImagingMaleMultivariate AnalysisNeuroimagingPractice Guidelines as TopicRacial GroupsRetrospective StudiesSex FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTomography, X-Ray ComputedConceptsEmergency department arrivalBrain imagingSymptom onsetHealth Stroke Scale scoreFuture quality improvement initiativesGuidelines-Stroke programStroke Scale scoreStroke symptom onsetAcute stroke symptomsHistory of diabetesPeripheral vascular diseaseMultivariable logistic regressionQuality improvement initiativesEffectiveness of thrombolysisOverall imaging rateProsthetic heart valvesPredictive variablesAcute strokeMost patientsHospital clusteringIndependent predictorsStroke symptomsNonwhite raceEmergency departmentVascular disease