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Inequities in Telemedicine Use Among Patients With Stroke and Cerebrovascular Diseases: A Tricenter Cross-sectional Study
Discussion In our diverse cohort across 3 centers, we found differences in TM visit type by race and insurance early during the COVID-19 pandemic. These findings suggest disparities in VTM access across different stroke populations. As VTM remains an integral part of outpatient neurology practice, steps to ensure equitable access are essential.
Source: Neurology Clinical Practice - March 14, 2023 Category: Neurology Authors: Naqvi, I. A., Cohen, A. S., Kim, Y., Harris, J., Denny, M. C., Strobino, K., Bicher, N., Leite, R. A., Sadowsky, D., Adegboye, C., Okpala, N., Okpala, M., Savitz, S. I., Marshall, R. S., Sharrief, A. Tags: All Health Services Research, All Cerebrovascular disease/Stroke, Underserved populations, Health disparities Research Article Source Type: research

Rate and Predictors of Acute Care Encounters in the First Month After Stroke
Hospital readmission has become an important quality metric, especially after the Affordable Care Act mandated a reduction in payments to hospitals with readmission rates higher than expected.1 The Centers for Medicare and Medicaid Services (CMS) defines 30-day stroke readmission as a hospital-specific readmission for any cause, except for certain planned readmissions, within 30 days after the date of discharge of the index admission.2 This definition does not take in account patients who are readmitted to other hospitals.
Source: Journal of Stroke and Cerebrovascular Diseases - April 4, 2022 Category: Neurology Authors: Haitham M. Hussein, Ella A. Chrenka, Amanda A. Herrmann Source Type: research

National Institutes of Health Stroke Scale Correlates Well with Initial Intracerebral Hemorrhage Volume
The US Centers for Medicare and Medicaid Services (CMS) currently publicly reports hospital-quality, risk-adjusted mortality measure for ischemic stroke but not intracerebral hemorrhage (ICH). The NIHSS, which is captured in CMS administrative claims data, is a candidate metric for use in ICH risk adjustment and has been shown to predict clinical outcome with accuracy similar to the ICH Score. Correlation between early NIHSS and initial ICH volume would further support use of the NIHSS for ICH risk adjustment.
Source: Journal of Stroke and Cerebrovascular Diseases - February 10, 2022 Category: Neurology Authors: Salman Farooq, Kristina Shkirkova, Pablo Villablanca, Nerses Sanossian, David S. Liebeskind, Sidney Starkman, Gilda Avila, Latisha Sharma, May Kim-Tenser, Suzie Gasparian, Marc Eckstein, Robin Conwit, Scott Hamilton, Jeffrey L. Saver Tags: Original Article Source Type: research

Quality Improvement Metrics and Methods for Neurohospitalists
Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, per...
Source: Neurologic Clinics - November 17, 2021 Category: Neurology Authors: Kathryn A. Kvam, Eric Bernier, Carl A. Gold Source Type: research

Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder
ConclusionUsing large US claims data, we found no evidence of increased SCV risk in children and adolescents with ADHD or ASD exposed to ADHD medications.
Source: CNS Drugs - November 24, 2019 Category: Neurology Source Type: research

Hospital Quality Metrics: “America's Best Hospitals” and Outcomes After Ischemic Stroke
Background: Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News& World Report ranking of “America's Best Hospitals” is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stro ke measures. Methods: The analysis was based on the 2015-2016 U.S.
Source: Journal of Stroke and Cerebrovascular Diseases - November 8, 2018 Category: Neurology Authors: Judith H. Lichtman, Erica C. Leifheit, Yun Wang, Larry B. Goldstein Source Type: research

Identification of reversible causes of minority inequity in stroke: severity related to race and socio-economic status.
CONCLUSIONS: Patients who are uninsured minorities may be at an increased risk for severe strokes. This increase in risk appears to be related to the increased incidence of risk factors and lack of treatment. The lack of funds, care access, and limited education in these patients may be related to their increase in risk factors. This paper identifies potentially reversible environmental and societal factors that can lead to improved outcomes in indigent minority patients. PMID: 30325276 [PubMed - in process]
Source: Brain Injury - October 17, 2018 Category: Neurology Tags: Brain Inj Source Type: research

Retention of Stroke Education Provided during Hospitalization: Does Provision of Required Education Increase Stroke Knowledge?
Discussion: While stroke education is required during hospitalization, its ability to produce retention may be poor. We propose study of test-enhanced learning methods through the Targeted Education in Stroke Trial (TEST) to examine the effect of novel teaching methods on patient/caregiver knowledge retention.Intervent Neurol 2018;7:471 –478
Source: Interventional Neurology - July 26, 2018 Category: Neurology Source Type: research

Endovascular Therapy and Ethnic Disparities in Stroke Outcomes
Conclusions: Despite unique baseline characteristics, African-Americans treated with ET for large vessel occlusion strokes have similar outcomes as Caucasians. Greater availability of ET may diminish the ethnic/racial disparities in stroke outcomes.Intervent Neurol 2018;7:389 –398
Source: Interventional Neurology - June 19, 2018 Category: Neurology Source Type: research

Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization Clinical Sciences
Conclusions—We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services’ existing stroke mortality measure, adjust for stroke severity, and could be implemented in a variety of settings.
Source: Stroke - October 23, 2017 Category: Neurology Authors: Jennifer Schwartz, Yongfei Wang, Li Qin, Lee H. Schwamm, Gregg C. Fonarow, Nicole Cormier, Karen Dorsey, Robert L. McNamara, Lisa G. Suter, Harlan M. Krumholz, Susannah M. Bernheim Tags: Health Services, Mortality/Survival, Quality and Outcomes, Ischemic Stroke Original Contributions Source Type: research

Cost of Alteplase Has More Than Doubled Over the Past Decade Brief Report
Conclusions—We found a striking increase in the cost of alteplase over the last decade, with a 100 mg vial now with a CMS payment of ≈$6400, a>100% increase over 10 years. During the same time frame, the DRG base payment to hospitals increased by only 8%, and alteplase cost increased from 27% of the payment in 2006 to 53% in 2013. Researchers and stroke physicians should be aware of these changes in drug costs and their impact on cost-effectiveness analyses.
Source: Stroke - June 26, 2017 Category: Neurology Authors: Dawn Kleindorfer, Joseph Broderick, Bart Demaerschalk, Jeffrey Saver Tags: Cost-Effectiveness, Ischemic Stroke Brief Reports Source Type: research

Early transition to comfort measures only in acute stroke patients: Analysis from the Get With The Guidelines-Stroke registry
Conclusions: Early CMO was utilized in about 5% of stroke patients, being more common in ICH and SAH than IS. Early CMO use varies widely between hospitals and is influenced by patient and hospital characteristics.
Source: Neurology Clinical Practice - June 12, 2017 Category: Neurology Authors: Prabhakaran, S., Cox, M., Lytle, B., Schulte, P. J., Xian, Y., Zahuranec, D., Smith, E. E., Reeves, M., Fonarow, G. C., Schwamm, L. H. Tags: All Cerebrovascular disease/Stroke, Palliative care Research Source Type: research

National trends in utilization of Intravenous thrombolysis and endovascular treatment in acute ischemic stroke (P5.044)
Conclusions:At national level, use of intravenous rt-PA is increasing among all groups proving positive impact of the efforts by organizations and patient education. Given endovascular treatment has now become standard of care; we need to create stroke care models to target this most vulnerable subset of patient population including Hispanics, patients residing in rural areas and insurance status like Medicaid or self-pay status to provide them similar and equal opportunities of treatment as others.Disclosure: Dr. Khatri has nothing to disclose. Dr. Afzal has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Qu...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Khatri, R., rauf-afzal, m., Qureshi, M. A., Qureshi, I. A., Maud, A., Rodriguez, G., Cruz-Flores, S. Tags: Neurocritical Care: Ischemic Injury Source Type: research

Getting to the Core of Stroke Care: Real Time Chart Review Improves Hospital Compliance with Core Measures (P6.269)
Conclusions:Real time chart review, utilization of a MQA, and alerting of providers is significantly more effective than a process utilizing retrospective chart review based on sampling and manual abstraction in increasing CM compliance. Implementation of these methods reduces CM deficiencies and leads to improved stroke care.Disclosure: Dr. Katsafanas has nothing to disclose. Dr. Furbeyre has nothing to disclose. Dr. Coppen has nothing to disclose. Dr. Hodges has nothing to disclose. Dr. Schnepel has nothing to disclose. Dr. Falk has nothing to disclose. Dr. Alonso has nothing to disclose. Dr. Tran has nothing to disclose...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Katsafanas, C., Furbeyre, J., Coppen, V., Hodges, W., Schnepel, L., Falk, D., Alonso, J., Tran, A., Northcut, M., Toback, A., Silliman, S. Tags: Cerebrovascular Disease Health Services Research Source Type: research

Derivation and Validation of a Proposed Long Length of Stay (>= 7 days) Score in Patients Hospitalized for Acute Ischemic Stroke (P1.067)
Conclusions:Many factors play a role in determining the length of stay for AIS patients. Our study provides a scoring system that may help physicians predict which patients are more likely to have a prolonged hospital stay.Disclosure: Dr. Mahmood has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Chauhan has nothing to disclose. Dr. Bianchi has nothing to disclose. Dr. Singhal has received personal compensation for activities with Medicolegal, ACTION Trial Stroke, Biogen, and Dock Technologies. Dr. Singhal holds stock and/or stock options in Biogen. Dr. Singhal has received research support from Boehringer Ingel...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Mahmood, S., Ali, S., Chauhan, M. A., Bianchi, N., Singhal, A., Schwamm, L. Tags: Practice, Policy, and Ethics I Source Type: research

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