Stroke is the 3rd leading cause of death and one of the leading causes of adult long-term disability in the US, with high impact for African Americans. Since 90% of stroke survivors are functionally impaired, improving stroke outcomes is a major public health issue. Agencies such as CMS and the Joint Commission have implemented performance programs including quality indicators (QIs) which would ideally be selected based on impact on stroke-related outcomes, but such evidence is currently scant. The Institute of Medicine has stated "that unbiased, reliable information about what works in health care is essential to reducing geographic variation in the use of health care services, and improving quality." We propose to systematically study Qls related to acute ischemic stroke (AIS) care and their associations with the outcomes of cardiovascular disease [CVD] mortality, CVD events, and functional independence. The overall goal is to develop a set of "optimal" AIS care Qls that maximizes long term outcomes both for patients overall and for specific groups of patients, such as African Americans, and AIS patients with chronic kidney disease (CKD) or diabetes, both more common among African Americans.
We aim to 1) examine variations in guideline-concordant process of AIS management, hypothesizing that guideline concordant care will vary by patient, hospital and regional factors, and that adherence to CMS Qls but not other potential Qls will improve over 2003-12;2) examine associations between processes of AIS management and outcomes, including incremental and relative effectiveness and cost-effectiveness in the >70% with CMS data. hypothesizing that guideline concordant care is associated with lower in-hospital complications and mortality, and that one year later, guideline-concordant inpatient care during the initial AIS hospitalization is associated with lower recurrent stroke, myocardial infarction (Ml), CVD mortality and higher functional independence;3) examine the association between processes of AIS management and outcomes in AIS patients with CKD or diabetes, hypothesizing that patients with CKD or diabetes will receive less guideline-concordant care than others, and that CKD and diabetes patients receiving guideline-concordant care will have better outcomes than others, but the set of Qls that optimizes quality of life for CKD and diabetes patients will differ compared with those for AIS patients overall. The study will consist of formal chart abstraction of processes of AIS care among 1200 REGARDS subjects, and will use publically available data on hospital characteristics, as well as CMS data.

Public Health Relevance

Stroke outcomes are worse for African Americans than for others in the US. This study will examine medical care provided to 1200 individuals who suffered an acute ischemic stroke to determine which types of care provided during their hospitalization lead to the best outcomes further down the road, and how to optimize outcomes for people who already had diabetes or chronic kidney disease at the time of their stroke.

National Institute of Health (NIH)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1)
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University of Alabama Birmingham
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Boehme, Amelia K; Siegler, James E; Mullen, Michael T et al. (2014) Racial and gender differences in stroke severity, outcomes, and treatment in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 23:e255-61
Boehme, Amelia K; Rawal, Pawan V; Lyerly, Michael J et al. (2014) Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt. J Stroke Cerebrovasc Dis 23:2001-6
Petrov, Megan E; Sawyer, Patricia; Kennedy, Richard et al. (2014) Benzodiazepine (BZD) use in community-dwelling older adults: Longitudinal associations with mobility, functioning, and pain. Arch Gerontol Geriatr 59:331-7
Petrov, Megan E; Howard, Virginia J; Kleindorfer, Dawn et al. (2014) Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study. J Stroke Cerebrovasc Dis 23:2110-6
Chang, Tiffany R; Albright, Karen C; Boehme, Amelia K et al. (2014) Factor VIII in the setting of acute ischemic stroke among patients with suspected hypercoagulable state. Clin Appl Thromb Hemost 20:124-8
Mullen, Michael T; Wiebe, Douglas J; Bowman, Ariel et al. (2014) Disparities in accessibility of certified primary stroke centers. Stroke 45:3381-8
Lyerly, Michael J; Houston, J Thomas; Boehme, Amelia K et al. (2014) Safety of intravenous tissue plasminogen activator administration with computed tomography evidence of prior infarction. J Stroke Cerebrovasc Dis 23:1657-61
Boehme, Amelia K; Kapoor, Niren; Albright, Karen C et al. (2014) Predictors of systemic inflammatory response syndrome in ischemic stroke undergoing systemic thrombolysis with intravenous tissue plasminogen activator. J Stroke Cerebrovasc Dis 23:e271-6
Mathias, Tiffany L; Albright, Karen C; Boehme, Amelia K et al. (2014) The Impact of Myocardial Infarction vs. Pneumonia on Outcome in Acute Ischemic Stroke. J Cardiovasc Dis 2:1-3
Petrov, Megan E; Kim, Yongin; Lauderdale, Diane S et al. (2014) Objective sleep, a novel risk factor for alterations in kidney function: the CARDIA study. Sleep Med 15:1140-6

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