Ischemic Stroke
Conditions
Keywords
CVA, Ischemic stroke
Brief summary
Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke: 1. Treatment with statins, 2. Control of hypertension, and 3. Anticoagulation in patients with atrial fibrillation.
Detailed description
There are several proven strategies for prevention of recurrent ischemic stroke, including use of statins, treatment of hypertension, and anticoagulation in patients with atrial fibrillation. Preliminary analyses suggest that only 9-15% of Kaiser Permanente Northern California's ischemic stroke patients receive optimal care for secondary prevention of stroke. The purpose of this study is to determine whether or not a quality improvement (QI) intervention can improve the care received by stroke patients. This project consists of a randomized trial of standardized stroke discharge order forms to improve adherence with best practices in secondary stroke prevention. The primary research question is: Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke: (1) treatment with statins, (2) control of hypertension, and (3) anticoagulation in patients with atrial fibrillation. The primary outcome will be the proportion of patients receiving optimal treatment, as defined by these three goals. The impact of the intervention will be measures as a change after-to-before at intervention hospitals compared to non-intervention (control) hospitals, with the institution as the unit of analysis. Secondary analyses will evaluate the impact of the intervention on each of these components and on 6-month and 1-year rates of mortality, readmission for stroke, and costs of care after discharge.
Interventions
Sponsors
Kaiser Permanente
University of California, San Francisco
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
SINGLE
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Ischemic stroke Kaiser-Permanente Health Plan Member with Pharmacy Benefit Discharged alive to home
Exclusion criteria
tpA patients Hemorrhagic stroke TIA Significant comorbidities
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Medication utilization | — |
| Best Practices | — |
| Recurrent stroke | — |
Secondary
| Measure | Time frame |
|---|---|
| Mortality | — |
| Hospital readmission | — |
| Morbidity | — |
| Cost | — |
Countries
United States
Outcome results
None listed