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 initiativesReimagining Stroke Quality of Care in the Age of Artificial Intelligence and Digital Enablement
Schwamm L. Reimagining Stroke Quality of Care in the Age of Artificial Intelligence and Digital Enablement. Stroke 2024, 55: 1683-1685. PMID: 38380550, DOI: 10.1161/strokeaha.123.044251.Peer-Reviewed Original Research
2020
Impact of Emergency Department Crowding on Delays in Acute Stroke Care
Jaffe T, Goldstein J, Yun B, Etherton M, Leslie-Mazwi T, Schwamm L, Zachrison K. Impact of Emergency Department Crowding on Delays in Acute Stroke Care. Western Journal Of Emergency Medicine 2020, 21: 892-899. PMID: 32726261, PMCID: PMC7390586, DOI: 10.5811/westjem.2020.5.45873.Peer-Reviewed Original ResearchConceptsAcute stroke careStroke careED crowdingEndovascular therapyConsecutive acute ischemic stroke patientsCare deliveryAcute ischemic stroke patientsGroin puncture timeGuidelines-Stroke registryStroke care deliveryHealth Stroke ScaleIschemic stroke patientsMultiple clinical factorsUrban academic EDInitial stroke severityHigh ED utilizationSingle-institution analysisAcute care deliveryEmergency stroke careOutcomes of interestWilcoxon rank sum testEmergency department (ED) crowdingRank sum testAlteplase deliveryDTN time
2019
Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke
Song S, Liang L, Fonarow G, Smith E, Bhatt D, Matsouaka R, Xian Y, Schwamm L, Saver J. Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke. JAMA Neurology 2019, 76: 430-439. PMID: 30667466, PMCID: PMC6459126, DOI: 10.1001/jamaneurol.2018.4410.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAsianBrain IschemiaFemaleFibrinolytic AgentsHealthcare DisparitiesHospital MortalityHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntracranial HemorrhagesLogistic ModelsMaleMiddle AgedMultivariate AnalysisPatient DischargeQuality of Health CareRetrospective StudiesSeverity of Illness IndexStrokeStroke RehabilitationThrombolytic TherapyTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeAsian American patientsIschemic strokeWhite patientsAmerican patientsClinical outcomesHospital mortalityStroke severityAmerican Heart Association/American Stroke AssociationIntravenous tissue plasminogen activator administrationTissue plasminogen activator administrationMultivariable logistic regression modelGreater stroke severityGuidelines-Stroke programGWTG-Stroke hospitalsIntensive statin therapyOverall stroke incidenceIn-Hospital OutcomesSevere ischemic strokeWorse functional outcomeAmerican Stroke AssociationQuality improvement registryLogistic regression modelsRace/ethnicityStatin therapy
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 evaluationHospitalQuality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference
Messé S, Mullen M, Cox M, Fonarow G, Smith E, Saver J, Reeves M, Bhatt D, Matsouaka R, Schwamm L. Quality of Care and Outcomes for Patients With Stroke in the United States Admitted During the International Stroke Conference. Journal Of The American Heart Association 2018, 7: e009842. PMID: 30376750, PMCID: PMC6404171, DOI: 10.1161/jaha.118.009842.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorTissue plasminogen activatorAcute ischemic strokeInternational Stroke ConferencePlasminogen activatorWorse outcomesGuideline-adherent careGuidelines-Stroke hospitalsRetrospective cohort studyHours of onsetMinutes of arrivalExperience worse outcomesQuality of careSame quality careAverage weekly numberGuidelines-StrokeAcute strokeBackground PatientsCohort studyConclusions PatientsIschemic strokeClinical outcomesMean ageStroke cliniciansHospital characteristicsInternational 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 preventionQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospitalClinical Performance Measures for Adults Hospitalized With Intracerebral Hemorrhage
Hemphill JC, Adeoye OM, Alexander DN, Alexandrov AW, Amin-Hanjani S, Cushman M, George MG, LeRoux PD, Mayer SA, Qureshi AI, Saver JL, Schwamm LH, Sheth KN, Tirschwell D. Clinical Performance Measures for Adults Hospitalized With Intracerebral Hemorrhage. Stroke 2018, 49: e243-e261. PMID: 29786566, DOI: 10.1161/str.0000000000000171.Peer-Reviewed Original ResearchAmerican Heart AssociationCerebral HemorrhageHealth PersonnelHumansQuality of Health CareUnited States
2017
Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network
Moreno A, Schwamm L, Siddiqui K, Viswanathan A, Whitney C, Rost N, Zachrison K. Frequent Hub–Spoke Contact Is Associated with Improved Spoke Hospital Performance: Results from the Massachusetts General Hospital Telestroke Network. Telemedicine Journal And E-Health 2017, 24: 678-683. PMID: 29271703, PMCID: PMC6014912, DOI: 10.1089/tmj.2017.0252.Peer-Reviewed Original ResearchConceptsDTN timePatient presentationTelestroke consultsTelestroke networkPatient-level regression analysesAcute ischemic stroke patientsShorter DTN timesIschemic stroke patientsFrequent contactPrimary predictor variableMedian DTNTPA administrationNeedle timeTPA useSpoke hospitalsStroke patientsMore frequent contactsHub hospitalImproved outcomesMedian numberTPA deliveryPatientsHospitalRegression analysisTelestrokeProfessional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English
Erfe B, Siddiqui K, Schwamm L, Kirwan C, Nunes A, Mejia N. Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English. Journal Of The American Heart Association 2017, 6: e006175. PMID: 28935679, PMCID: PMC5634277, DOI: 10.1161/jaha.117.006175.Peer-Reviewed Original ResearchConceptsProfessional medical interpretersMedical interpretersAcute ischemic stroke careIschemic stroke careAcute ischemic stroke patientsIschemic stroke patientsStroke carePMI servicesCommon languageEnglishLanguageStroke patientsInterpretersGuidelines-Stroke programAmerican Heart AssociationAppropriate health careLogistic regression modelsQuality patient careHospital stayMultivariable analysisPatient receiptHeart AssociationLower oddsPatientsMedical careAmerican Heart Association’s Call to Action for Payment and Delivery System Reform
Bufalino V, Berkowitz S, Gardner T, Piña I, Konig M, Bauman M, Barbouche M, Creager M, Fonarow G, Gibbons R, Meltzer D, Meltzer N, Schwamm L, Warner J. American Heart Association’s Call to Action for Payment and Delivery System Reform. Circulation 2017, 136: e162-e171. PMID: 28696250, DOI: 10.1161/cir.0000000000000516.Peer-Reviewed Original ResearchMeSH KeywordsAccountable Care OrganizationsAmerican Heart AssociationHealth ExpendituresHealth PolicyHumansInsurance, Health, ReimbursementQuality of Health CareUnited StatesConceptsAmerican Heart AssociationHeart AssociationDelivery system reformPatient-centered medical homeExpert panelDelivery system transformationAccountable care organizationsMedical homeHealth professionalsPatient careMedical careInterests of patientsBaseline reviewHealthcare systemCare organizationsParticular medicinePrivate payersAssociationPayment modelsCareDelivery modelAlternative deliverySystem reformFurther involvementPatientsHealthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes
O'Brien E, Wu J, Zhao X, Schulte P, Fonarow G, Hernandez A, Schwamm L, Peterson E, Bhatt D, Smith E. Healthcare Resource Availability, Quality of Care, and Acute Ischemic Stroke Outcomes. Journal Of The American Heart Association 2017, 6: e003813. PMID: 28159820, PMCID: PMC5523738, DOI: 10.1161/jaha.116.003813.Peer-Reviewed Original ResearchConceptsHealthcare resource availabilityHospital referral regionsQuality of careReferral regionsHealthcare resourcesAcute ischemic stroke outcomesAcute ischemic stroke treatmentGuidelines-Stroke hospitalsIschemic stroke outcomeIschemic stroke patientsIschemic stroke treatmentMultivariable logistic regressionLength of stayHospital-based resourcesGuidelines-StrokeHospital mortalityHospital outcomesStroke outcomeStroke careStroke treatmentStroke patientsCare resourcesHealth care dataHospital qualityStroke qualityImpact of an Expanded Hospital Recognition Program for Stroke Quality of Care
Heidenreich P, Zhao X, Hernandez A, Schwamm L, Smith E, Reeves M, Peterson E, Fonarow G. Impact of an Expanded Hospital Recognition Program for Stroke Quality of Care. Journal Of The American Heart Association 2017, 6: e004278. PMID: 28110310, PMCID: PMC5523627, DOI: 10.1161/jaha.116.004278.Peer-Reviewed Original ResearchMeSH KeywordsAgedAwards and PrizesFemaleGuideline AdherenceHospitalsHumansMalePractice Guidelines as TopicQuality Indicators, Health CareQuality of Health CareStroke
2016
Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization
Man S, Cox M, Patel P, Smith E, Reeves M, Saver J, Bhatt D, Xian Y, Schwamm L, Fonarow G. Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization. Stroke 2016, 48: 412-419. PMID: 28008094, DOI: 10.1161/strokeaha.116.014426.Peer-Reviewed Original ResearchConceptsHealthcare Facilities Accreditation ProgramPSC certificationStroke patientsJoint CommissionIntravenous tissue-type plasminogen activator useHospital risk-adjusted mortalityAcute ischemic stroke patientsStroke qualityAcute ischemic stroke admissionsCare qualityPrimary stroke center certificationGuidelines-Stroke hospitalsStroke center certificationIschemic stroke patientsIschemic stroke admissionsRisk-adjusted mortalityEvidence-based careSystems of careAccreditation programGuidelines-StrokeHospital outcomesNeedle timeStroke admissionsCenter certificationGroup of hospitalsTelemedicine Quality and Outcomes in Stroke
Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, Hess DC, Majersik JJ, Nystrom KV, Reeves MJ, Rosamond WD, Switzer JA. Telemedicine Quality and Outcomes in Stroke. Stroke 2016, 48: e3-e25. PMID: 27811332, DOI: 10.1161/str.0000000000000114.Peer-Reviewed Original ResearchSubstantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow G, Schwamm L, Hu B, Peterson E, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016, 47: 2843-2849. PMID: 27758941, DOI: 10.1161/strokeaha.116.014143.Peer-Reviewed Original ResearchMeSH KeywordsAgedChinaFemaleGuideline AdherenceHumansMaleMiddle AgedQuality of Health CareRegistriesStrokeConceptsChina National Stroke RegistryIntravenous thrombolytic therapyNational Stroke RegistryQuality Improvement ProgramHigher composite scoresStroke RegistryDysphagia screeningStroke careThrombolytic therapyAtrial fibrillationSmoking cessationLeading causeStroke educationMultivariate analysisStudy periodAdherenceComposite scoreHospitalPhase 2Phase 1CareRegression modelsOddsOverall qualitySignificant improvementHospital Variation in Home-Time After Acute Ischemic Stroke
O'Brien E, Xian Y, Xu H, Wu J, Saver J, Smith E, Schwamm L, Peterson E, Reeves M, Bhatt D, Maisch L, Hannah D, Lindholm B, Olson D, Prvu Bettger J, Pencina M, Hernandez A, Fonarow G. Hospital Variation in Home-Time After Acute Ischemic Stroke. Stroke 2016, 47: 2627-2633. PMID: 27625383, DOI: 10.1161/strokeaha.116.013563.Peer-Reviewed Original ResearchConceptsIschemic strokeStroke survivorsStroke volumeAdmission volumePost dischargeAcute ischemic strokeIschemic stroke survivorsHighest priority outcomesMore comorbiditiesRegistry patientsSevere strokeHospital factorsAdjusted analysisHospital variationHospital characteristicsPost strokeMedicare claimsRural locationsHospitalStrokePatientsRisk adjustmentLinear mixed modelsFirst yearSurvivors
2015
National stroke registries for monitoring and improving the quality of hospital care: A systematic review
Cadilhac D, Kim J, Lannin N, Kapral M, Schwamm L, Dennis M, Norrving B, Meretoja A. National stroke registries for monitoring and improving the quality of hospital care: A systematic review. International Journal Of Stroke 2015, 11: 28-40. PMID: 26763018, DOI: 10.1177/1747493015607523.Peer-Reviewed Original ResearchConceptsStroke careNational strokePatient outcomesNational Stroke RegistryAcute stroke careEvidence-based careHospital-based strokeStroke RegistryNational registryHospital careInitial keyword searchRegistrySystematic reviewPatient consentData linkagePotential papersSystematic searchMost registriesCareStrokeOutcomesBetter awarenessRoutine monitoringCurrent useBetter accessQuality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack
O'Brien E, Zhao X, Fonarow G, Schulte P, Dai D, Smith E, Schwamm L, Bhatt D, Xian Y, Saver J, Reeves M, Peterson E, Hernandez A. Quality of Care and Ischemic Stroke Risk After Hospitalization for Transient Ischemic Attack. Circulation Cardiovascular Quality And Outcomes 2015, 8: s117-s124. PMID: 26515199, DOI: 10.1161/circoutcomes.115.002048.Peer-Reviewed Original ResearchConceptsTransient ischemic attackDefect-free careIschemic strokeIschemic stroke riskQuality of careIschemic attackStroke riskCare measuresRisk scoreOverall hospital admission rateRisk score quintilesYear post dischargeLow-risk patientsHospital admission ratesIschemic stroke admissionsPrevious myocardial infarctionAbsence of strokeMedicare inpatient claimsCox proportional hazardsModerate discriminative performanceTIA patientsCause mortalityCessation counselingStroke admissionsBaseline demographics