The candidate's long term professional goals are to develop an independent career in stroke research with a focus on quality of care, the impact of stroke care on patient outcomes and methods for improving the delivery of evidence-based care. To achieve these goals the candidate has developed a five-year career development plan involving a formal degree in Health Services Research (Outcomes Concentration) and the following mentored research project. Stroke mortality in the United States has declined rapidly in the 1970s and 1980s. However, this decline has slowed despite numerous advances in stroke treatments in the 1990s. The proposed research focuses on the evidence-practice gap as an explanation for the flattening of stroke mortality despite treatment advances in stroke care. We will use a population-based data set compiled in the Minneapolis-St. Paul area hospitals by the Project to Improve Stroke Care Management in Minnesota, an AHRQ funded clinical trial designed to examine the quality of acute ischemic stroke care. This database will be augmented by mortality data and by Medicare files compiled by the Center for Medicare and Medicaid Services. The proposed grant will use these data to accomplish the following aims: 1) Describe a comprehensive profile of outcomes in a population of patients hospitalized with acute ischemic stroke, 2) Model acute ischemic stroke outcomes in terms of care received, 3) Identify patient, clinician and hospital determinants of quality of stroke care. In addition, we will develop and pilot test an intervention designed to improve compliance with evidence-based quality of care indicators at one hospital. This pilot study will form the basis for a R01 grant designed to examine interventions for improving the delivery of evidence-based stroke care in community hospitals. Relevance to public health: Our work utilizes a population-based data set and hence our results on stroke outcomes will describe the natural history of the disease in a population of stroke patients. Our results on the determinants of quality of care have numerous public health implications since it will inform us as to the appropriate areas to target quality improvement initiatives. We anticipate that our pilot study will eventually be scaled to a larger study involving community hospitals.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS051377-02
Application #
7454316
Study Section
NST-2 Subcommittee (NST)
Program Officer
Jacobs, Tom P
Project Start
2007-07-01
Project End
2012-06-30
Budget Start
2008-07-01
Budget End
2009-06-30
Support Year
2
Fiscal Year
2008
Total Cost
$163,113
Indirect Cost
Name
University of Minnesota Twin Cities
Department
Neurology
Type
Schools of Medicine
DUNS #
555917996
City
Minneapolis
State
MN
Country
United States
Zip Code
55455
Asaithambi, Ganesh; Tong, Xin; George, Mary G et al. (2014) Acute stroke reperfusion therapy trends in the expanded treatment window era. J Stroke Cerebrovasc Dis 23:2316-21
Lakshminarayan, Kamakshi; Berger, Alan K; Fuller, Candace C et al. (2014) Trends in 10-year survival of patients with stroke hospitalized between 1980 and 2000: the Minnesota stroke survey. Stroke 45:2575-81
Georgiadis, Alexandros L; Cordina, Steve M; Vazquez, Gabriela et al. (2013) Aspirin treatment failure and the risk of recurrent stroke and death among patients with ischemic stroke. J Stroke Cerebrovasc Dis 22:100-6
Lakshminarayan, Kamakshi; Rostambeigi, Nassir; Fuller, Candace C et al. (2012) Impact of an electronic medical record-based clinical decision support tool for dysphagia screening on care quality. Stroke 43:3399-401
Lakshminarayan, Kamakshi; Schissel, Candace; Anderson, David C et al. (2011) Five-year rehospitalization outcomes in a cohort of patients with acute ischemic stroke: Medicare linkage study. Stroke 42:1556-62
Lakshminarayan, Kamakshi; Tsai, Albert W; Tong, Xin et al. (2010) Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke 41:2849-54
Lakshminarayan, K; Borbas, C; McLaughlin, B et al. (2010) A cluster-randomized trial to improve stroke care in hospitals. Neurology 74:1634-42
Lakshminarayan, Kamakshi; Anderson, David C; Jacobs Jr, David R et al. (2009) Stroke rates: 1980-2000: the Minnesota Stroke Survey. Am J Epidemiol 169:1070-8
Maud, Alberto; Lakshminarayan, Kamakshi; Suri, M Fareed K et al. (2009) Cost-effectiveness analysis of endovascular versus neurosurgical treatment for ruptured intracranial aneurysms in the United States. J Neurosurg 110:880-6
Lakshminarayan, Kamakshi; Peacock, James M; Luepker, Russell V et al. (2008) Thrombolytic Treatment After Acute Ischemic Stroke Results from the Minnesota Stroke Registry and Opportunities to Improve Care. J Vasc Interv Neurol 1:87-88

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