2023
Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension : An Observational Study.
Tang M, Nakamoto C, Stern A, Zubizarreta J, Marcondes F, Uscher-Pines L, Schwamm L, Mehrotra A. Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension : An Observational Study. Annals Of Internal Medicine 2023, 176: 1465-1475. PMID: 37931262, DOI: 10.7326/m23-1182.Peer-Reviewed Original ResearchConceptsObservational studyCare outcomesRemote patient monitoringAcute care encountersHypertension medication usePhysician outpatient visitsAcute care useChronic disease managementReceipt of careBlood pressure dataHypertension careUnique medicationsMedication usePrimary outcomeOutpatient visitsResidual confoundingCare useMedication fillsDays' supplyMedicare patientsCare encountersControl practicesHypertensionPatientsImaging useInsurance-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 proportionDepartmentAssociationShorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke
Man S, Solomon N, Mac Grory B, Alhanti B, Uchino K, Saver J, Smith E, Xian Y, Bhatt D, Schwamm L, Hussain M, Fonarow G. Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. Circulation 2023, 148: 20-34. PMID: 37199147, PMCID: PMC10356148, DOI: 10.1161/circulationaha.123.064053.Peer-Reviewed Original ResearchConceptsIntravenous thrombolytic therapyAcute ischemic strokeGood long-term functional outcomeLong-term functional outcomeShorter DTN timesEndovascular thrombectomyFunctional outcomeDTN timeIschemic strokeCause mortalityNeedle timeThrombolytic therapyCox proportional hazards modelModified Rankin Scale (mRS) 0Older US patientsRankin Scale 0Multivariate logistic regressionProportional hazards modelLongitudinal functional outcomesHome timeEligible patientsEVT candidatesEVT timesGuidelines-StrokeThrombolytic administrationVariation 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
Trends 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 periodConsultsPatientsEpisodesConsultationHomeHospitalStrokeProportionLegislation Increased Medicare Telestroke Billing, But Underbilling And Erroneous Billing Remain Common
Wilcock A, Schwamm L, Zubizarreta J, Zachrison K, Uscher-Pines L, Majersik J, Richard J, Mehrotra A. Legislation Increased Medicare Telestroke Billing, But Underbilling And Erroneous Billing Remain Common. Health Affairs 2022, 41: 350-359. PMID: 35254931, PMCID: PMC9188431, DOI: 10.1377/hlthaff.2021.00791.Peer-Reviewed Original Research
2021
Linking the Paul Coverdell National Acute Stroke Program to commercial claims to establish a framework for real-world longitudinal stroke research
Patorno E, Schneeweiss S, George M, Tong X, Franklin J, Pawar A, Mogun H, Moura L, Schwamm L. Linking the Paul Coverdell National Acute Stroke Program to commercial claims to establish a framework for real-world longitudinal stroke research. Stroke And Vascular Neurology 2021, 7: 114-123. PMID: 34750282, PMCID: PMC9067267, DOI: 10.1136/svn-2021-001134.Peer-Reviewed Original ResearchConceptsPaul Coverdell National Acute Stroke ProgramAcute Stroke ProgramClaims dataStroke ProgramStroke severityMedication useMedical historyReal-world patientsCare of patientsCommercial claims dataLongitudinal claims dataMedication utilisationStroke hospitalisationsStroke admissionsMost patientsCommercial ClaimsInpatient dataStroke researchDischarge usePatientsHigh quality linkageUnlinked patientsLab valuesStrokeOral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation
Saeed O, Zhang S, Patel S, Jorde U, Garcia M, Bulcha N, Gupta T, Xian Y, Matsouaka R, Shah S, Smith E, Schwamm L, Fonarow G. Oral Anticoagulation and Adverse Outcomes after Ischemic Stroke in Heart Failure Patients without Atrial Fibrillation. Journal Of Cardiac Failure 2021, 27: 857-864. PMID: 33975786, PMCID: PMC8355019, DOI: 10.1016/j.cardfail.2021.02.017.Peer-Reviewed Original ResearchConceptsOral anticoagulationRecurrent ischemic strokeAcute ischemic strokeIschemic strokeHeart failureAtrial fibrillationOlder patientsHistory of HFInitiation of OACCox proportional hazard ratiosProportional hazard ratiosHeart failure patientsKaplan-Meier curvesClinical registry dataCause bleedingEligible patientsAdverse eventsCumulative incidenceFailure patientsHazard ratioSuch patientsYear mortalityAdverse outcomesClinical covariatesRegistry dataPatterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors
Etherton M, Shah S, Haolin X, Xian Y, Maisch L, Hannah D, Lindholm B, Lytle B, Thomas L, Smith E, Fonarow G, Schwamm L, Bhatt D, Hernandez A, O'Brien E. Patterns of antidepressant therapy and clinical outcomes among ischaemic stroke survivors. Stroke And Vascular Neurology 2021, 6: 384-394. PMID: 33526632, PMCID: PMC8485250, DOI: 10.1136/svn-2020-000691.Peer-Reviewed Original ResearchConceptsAntidepressant medicationIschemic strokeCause mortalityClinical outcomesOutcome measuresAD useHealth Stroke Scale scoreHigher admission National InstitutesMajor adverse cardiac eventsAdmission National InstitutesGuidelines-Stroke hospitalsPrior ischemic strokeAdverse cardiac eventsIschemic stroke survivorsStroke Scale scorePoor prognostic signPoor clinical outcomeLogistic regression modelsFalsification endpointsAntidepressant therapyCause readmissionNaïve patientsCardiac eventsPoststroke depressionStroke severity
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 doorStrategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases
Zachrison K, Li S, Reeves M, Adeoye O, Camargo C, Schwamm L, Hsia R. Strategy for reliable identification of ischaemic stroke, thrombolytics and thrombectomy in large administrative databases. Stroke And Vascular Neurology 2020, 6: 194-200. PMID: 33177162, PMCID: PMC8258073, DOI: 10.1136/svn-2020-000533.Peer-Reviewed Original ResearchConceptsICD-9/ICDMS-DRG codesCurrent Procedural TerminologyEndovascular thrombectomyICD-10 codesLarge administrative databaseIschemic strokeICD codesDischarge codesEmergency departmentAdministrative databasesICD-9CPT codesThrombolytic-treated patientsMedicare severity diagnosisAdministrative dataInpatient hospitalisationThrombolytic treatmentED patientsInterhospital transferDiagnosis codesStroke researchInternational ClassificationPatientsProcedural TerminologyDisease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study
Kaufman B, Shah S, Hellkamp A, Lytle B, Fonarow G, Schwamm L, Lesén E, Hedberg J, Tank A, Fita E, Bhalla N, Atreja N, Bettger J. Disease Burden Following Non-Cardioembolic Minor Ischemic Stroke or High-Risk TIA: A GWTG-Stroke Study. Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 105399. PMID: 33254370, DOI: 10.1016/j.jstrokecerebrovasdis.2020.105399.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCost-Benefit AnalysisFee-for-Service PlansFemaleFunctional StatusHealth Care CostsHealth Services Needs and DemandHealth Services ResearchHospital CostsHumansIschemic Attack, TransientMaleMedicarePatient DischargeRegistriesRisk AssessmentRisk FactorsSeverity of Illness IndexStrokeTime FactorsTreatment OutcomeUnited StatesConceptsHigh-risk transient ischemic attackTransient ischemic attackMinor ischemic strokeIschemic strokeHigh-risk TIA patientsLimited real-world dataMedicare paymentsBurden of illnessClinical trial populationsMean Medicare paymentsImportant unmet needMedicare spendingIschemic attackTIA patientsAntiplatelet therapyIndex hospitalizationStroke RegistryComposite outcomeCumulative incidenceClinical outcomesTherapeutic optionsTrial populationFunctional statusDisease burdenPatient outcomesPatterns of anticonvulsant use and adverse drug events in older adults
Moura L, Smith J, Yan Z, Blacker D, Schwamm L, Newhouse J, Hernandez‐Diaz S, Hsu J. Patterns of anticonvulsant use and adverse drug events in older adults. Pharmacoepidemiology And Drug Safety 2020, 30: 28-36. PMID: 33009718, PMCID: PMC7849867, DOI: 10.1002/pds.5139.Peer-Reviewed Original ResearchConceptsAdverse drug eventsElectronic health recordsIncident usersAnticonvulsant useDrug eventsMedicare beneficiariesRate of ADEsSeverity of ADEsSignificant adverse drug eventsEligible beneficiariesOlder adultsCohort of communityDuration of useRange of indicationsTraditional Medicare beneficiariesInverse probability weightsADE ratesMonotherapy usersSingle anticonvulsantAnticonvulsant therapyPain reliefCommon indicationOriginal cohortNervous systemOlder adult communityAntiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke
Chang K, Xian Y, Zhao X, Mi X, Matsouaka R, Schwamm L, Shah S, Lytle B, Smith E, Bhatt D, Fonarow G, Hsu J. Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke. International Journal Of Cardiology 2020, 321: 88-94. PMID: 32805327, DOI: 10.1016/j.ijcard.2020.08.011.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeAntiplatelet therapyAntithrombotic therapyIschemic strokeTherapy prescriptionOral anticoagulationUnadjusted ratesGuidelines-Stroke registryService beneficiaries 65Retrospective cohort studyOral anticoagulant therapyAnticoagulant therapyCohort studyComposite endpointPrimary outcomeAtrial fibrillationAtrial flutterPotential confoundersNeurologic/Medicare beneficiariesMedicare feeTherapyStrokePatientsMortalityTrends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017
Wilcock A, Zachrison K, Schwamm L, Uscher-Pines L, Zubizarreta J, Mehrotra A. Trends Among Rural and Urban Medicare Beneficiaries in Care Delivery and Outcomes for Acute Stroke and Transient Ischemic Attacks, 2008-2017. JAMA Neurology 2020, 77: 863-871. PMID: 32364573, PMCID: PMC7358912, DOI: 10.1001/jamaneurol.2020.0770.Peer-Reviewed Original ResearchConceptsTransient ischemic attackAcute ischemic strokeIschemic attackAcute strokeStroke centersRural-urban disparitiesResidential zip codeIschemic strokeEnd-stage kidney diseaseRural-Urban Commuting Area codesDescriptive observational studyHealth care centersUrban Medicare beneficiariesQuality of careTraditional MedicareNeurologist evaluationOutcome patientsUrban patientsStroke careNeurology consultationKidney diseaseMean ageCare centerStroke systemsObservational studySafety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
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 dyadsThe Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study
Kaufman B, O’Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Song P, Schwamm L, Smith E, Fonarow G, Xian Y. The Medicare Shared Savings Program and Outcomes for Ischemic Stroke Patients: a Retrospective Cohort Study. Journal Of General Internal Medicine 2019, 34: 2740-2748. PMID: 31452032, PMCID: PMC6854149, DOI: 10.1007/s11606-019-05283-1.Peer-Reviewed Original ResearchConceptsAccountable care organizationsIschemic strokeRecurrent strokeMSSP accountable care organizationsIndex hospital stayIncident ischemic strokeRetrospective cohort studyAcute care utilizationIschemic stroke patientsMedicare Shared Savings Program Accountable Care OrganizationsModerate ischemic strokeConclusionsAmong patientsMain MeasuresOutcomesCause readmissionHospital stayCohort studyHome dischargeCare utilizationStroke patientsTransitional careProbability of dischargeCare coordinationPatient outcomesMedicare claimsService beneficiariesEpilepsy Among Elderly Medicare Beneficiaries
Moura L, Smith J, Blacker D, Vogeli C, Schwamm L, Cole A, Hernandez-Diaz S, Hsu J. Epilepsy Among Elderly Medicare Beneficiaries. Medical Care 2019, 57: 318-324. PMID: 30762723, PMCID: PMC6417929, DOI: 10.1097/mlr.0000000000001072.Peer-Reviewed Original ResearchConceptsMedicare administrative dataEpilepsy statusMedicare beneficiariesMedicare dataEpilepsy diagnosisElectronic health record dataElderly Medicare beneficiariesHealth record dataHealth insurance claimsAdministrative dataElectronic health recordsIncident epilepsyPrevalent epilepsyDrug claimsEpilepsyDiagnostic thresholdStratified random sampleInverse probabilityHealth recordsMedicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients
Kaufman B, O'Brien E, Stearns S, Matsouaka R, Holmes G, Weinberger M, Schwamm L, Smith E, Fonarow G, Xian Y, Taylor D. Medicare Shared Savings ACOs and Hospice Care for Ischemic Stroke Patients. Journal Of The American Geriatrics Society 2019, 67: 1402-1409. PMID: 30835818, DOI: 10.1111/jgs.15852.Peer-Reviewed Original ResearchConceptsIschemic stroke patientsHigher mortality riskHospice enrollmentStroke patientsAccountable care organizationsMortality riskMedicare Shared Savings ProgramComfort measuresLife careIncident ischemic stroke patientsLow-mortality risk groupsGWTG-Stroke hospitalsIncident ischemic strokeMortality risk groupsPalliative care servicesService Medicare beneficiariesQuality of endMedicare hospice benefitSevere strokeIschemic strokePoor prognosisNational registryReduced oddsRisk groupsHospice care