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Stroke utilization cost

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https://www.readbyqxmd.com/read/29346176/rapid-response-to-scan-or-not-to-scan-the-utility-of-noncontrast-ct-head-for-altered-mental-status
#1
Purujit J Thacker, Mansha Sethi, Jonathan Sternlieb, Doron Schneider, Mary Naglak, Rajeshkumar R Patel
OBJECTIVES: The aims of the study were the following: (1) to determine how often computed tomography (CT) scans of the head are obtained on rapid responses called for altered mental status (AMS), (2) to determine whether CT imaging of the head is required during all rapid responses called for AMS, (3) to determine which patients would benefit from CT scans of the head in this setting, (4) to note whether an adequate neurologic exam was documented, (5) to determine the cost of CT scans that did not change management, and (6) to examine the role of medications leading to AMS...
January 17, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29335013/fit-for-function-study-protocol-for-a-randomized-controlled-trial
#2
Julie Richardson, Ada Tang, Gordon Guyatt, Lehana Thabane, Feng Xie, Demetrios Sahlas, Robert Hart, Rebecca Fleck, Genevieve Hladysh, Louise Macrae
BACKGROUND: The current state of evidence suggests that community-based exercise programs are beneficial in improving impairment, function, and health status, and are greatly needed for persons with stroke. However, limitations of these studies include risk of bias, feasibility, and cost issues. METHODS/DESIGN: This single-blinded, randomized controlled trial (RCT) of 216 participants with stroke will compare the effectiveness of a 12-week YMCA community-based wellness program (FIT for FUNCTION) specifically designed for community-dwelling persons with stroke to persons who receive a standard YMCA membership...
January 15, 2018: Trials
https://www.readbyqxmd.com/read/29290177/health-care-resource-utilization-and-costs-among-newly-diagnosed-and-oral-anticoagulant-naive-nonvalvular-atrial-fibrillation-patients-treated-with-dabigatran-or-warfarin-in-the-united-states
#3
Rahul Jain, An-Chen Fu, Jonathan Lim, Cheng Wang, Jessica Elder, Stephen D Sander, Hiangkiat Tan
BACKGROUND: Warfarin has a long history of use to reduce the risk of stroke in patients with atrial fibrillation (AF), but it requires frequent laboratory monitoring to maintain international normalized ratio levels in the therapeutic range. Dabigatran, a novel oral anticoagulant (OAC), has demonstrated efficacy in reducing the risk of stroke and systemic embolism and does not require laboratory monitoring. OBJECTIVE: To compare health care resource utilization (HCRU) and costs of OAC-naive patients newly diagnosed with nonvalvular atrial fibrillation (NVAF), using dabigatran or warfarin...
January 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29230625/systemic-lupus-erythematosus-and-the-risk-of-perioperative-major-adverse-cardiovascular-events
#4
Nathaniel R Smilowitz, Gregory Katz, Jill P Buyon, Robert M Clancy, Jeffrey S Berger
Systemic lupus erythematosus (SLE) is a significant risk factor for cardiovascular disease. The relationship between SLE and perioperative cardiovascular risks following non-cardiac surgery is uncertain. We investigated associations between a diagnosis of SLE and outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥ 18 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014...
December 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29215510/timing-and-risk-factors-of-postpartum-stroke
#5
Gloria Too, Timothy Wen, Amelia K Boehme, Eliza C Miller, Lisa R Leffert, Frank J Attenello, William J Mack, Mary E DʼAlton, Alexander M Friedman
OBJECTIVE: To characterize risk and timing of postpartum stroke readmission after delivery hospitalization discharge. METHODS: The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for calendar years 2013 and 2014 was used to perform a retrospective cohort study evaluating risk of readmission for stroke within 60 days of discharge from a delivery hospitalization. Risk was characterized as odds ratios (ORs) with 95% CIs based on whether patients had hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), or chronic hypertension, or neither disorder during the index hospitalization...
January 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29187242/statistical-analysis-plan-for-the-eurohyp-1-trial-european-multicentre-randomised-phase-iii-clinical-trial-of-the-therapeutic-hypothermia-plus-best-medical-treatment-versus-best-medical-treatment-alone-for-acute-ischaemic-stroke
#6
Per Winkel, Philip M Bath, Christian Gluud, Jane Lindschou, H Bart van der Worp, Malcolm R Macleod, Istvan Szabo, Isabelle Durand-Zaleski, Stefan Schwab
BACKGROUND: Cooling may reduce infarct size and improve neurological outcomes in patients with ischaemic stroke. In phase II trials, cooling awake patients with ischaemic stroke has been shown to be feasible and safe, but the effects in functional outcomes has not yet been investigated in an adequately sized randomised clinical trial. METHODS/DESIGN: The EuroHYP-1 trial is a multinational, randomised, superiority phase III clinical trial with masked outcome assessment testing the benefits and harms of therapeutic cooling in awake adult patients with acute ischaemic stroke...
November 29, 2017: Trials
https://www.readbyqxmd.com/read/29175808/time-gain-needed-for-in-ambulance-telemedicine-cost-utility-model
#7
Alexis Valenzuela Espinoza, Stefanie Devos, Robbert-Jan van Hooff, Maaike Fobelets, Alain Dupont, Maarten Moens, Ives Hubloue, Door Lauwaert, Pieter Cornu, Raf Brouns, Koen Putman
BACKGROUND: Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine...
November 24, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29170312/15%C3%A2-a-clinical-decision-tool-for-prescribing-anti-platelet-medication-for-patients-with-suspected-acute-coronary-syndrome-pam
#8
Charles Reynard, Rick Body
BACKGROUND: The benefit of antiplatelet medication in confirmed acute coronary syndrome (ACS) is well established. In the Emergency Department (ED) diagnostic uncertainty may lead to over-treatment, with consequent risks (e.g., bleeding), or under-treatment, compromising clinical outcomes. Clinicians must subjectively balance the anticipated risks and benefits with their perceived probability of ACS in order to decide whether to prescribe these medications. We aimed to construct a clinical model to optimise and personalise recommendations for anti-platelet prescription in this context...
December 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/29155982/economic-and-survival-burden-of-dysphagia-among-inpatients-in-the-united-states
#9
D A Patel, S Krishnaswami, E Steger, E Conover, M F Vaezi, M R Ciucci, D O Francis
The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and in-hospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009-2013)...
November 16, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29118795/cost-analysis-of-the-addition-of-hyperacute-magnetic-resonance-imaging-for-selection-of-patients-for-endovascular-stroke-therapy
#10
Seby John, Nicolas R Thompson, Terry Lesko, Nancy Papesh, Nancy Obuchowski, Dan Tomic, Dolora Wisco, Zeshaun Khawaja, Ken Uchino, Shumei Man, Esteban Cheng-Ching, Gabor Toth, Thomas Masaryk, Paul Ruggieri, Michael Modic, Muhammad Shazam Hussain
Background and Purpose: Patient selection is important to determine the best candidates for endovascular stroke therapy. In application of a hyperacute magnetic resonance imaging (MRI) protocol for patient selection, we have shown decreased utilization with improved outcomes. A cost analysis comparing the pre- and post-MRI protocol time periods was performed to determine if the previous findings translated into cost opportunities. Materials and Methods: We retrospectively identified individuals considered for endovascular stroke therapy from January 2008 to August 2012 who were ≤8 h from stroke symptoms onset...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29100941/impact-of-clinical-pharmacist-services-delivered-via-telemedicine-in-the-outpatient-or-ambulatory-care-setting-a-systematic-review
#11
REVIEW
Joshua D Niznik, Harvey He, Sandra L Kane-Gill
BACKGROUND: Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE: Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS: A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE...
October 28, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/29083968/effect-of-apixaban-versus-warfarin-use-on-health-care-resource-utilization-and-costs-among-elderly-patients-with-nonvalvular-atrial-fibrillation
#12
Steven Deitelzweig, Xuemei Luo, Kiran Gupta, Jeffrey Trocio, Jack Mardekian, Tammy Curtice, Melissa Lingohr-Smith, Brandy Menges, Jay Lin
BACKGROUND: The clinical trial ARISTOTLE showed that apixaban was superior to warfarin in reducing the risks of stroke and bleeding among patients with nonvalvular atrial fibrillation (NVAF). Further study of the effect of apixaban versus warfarin use on health care resource utilization (HCRU) and associated costs in the real-world setting is warranted, especially among elderly patients who are at higher risk of stroke and bleeding. OBJECTIVE: To compare HCRU and costs among elderly NVAF patients treated with apixaban versus warfarin in the United States...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29082335/atrial-fibrillation-trial-to-evaluate-real-world-procedures-for-their-utility-in-helping-to-lower-stroke-events-after-pulse-study-protocol-for-a-randomized-controlled-trial
#13
Tsung-Ta Hsieh, Meng Lee, Wen-Yi Huang, Sung-Chun Tang, Sheng-Feng Sung, Kuo-Husan Chang, Jiann-Der Lee, Tsong-Hai Lee, Yung-Sung Huang, Jiann-Shing Jeng, Chang-Min Chung, Yi-Ling Wu, Bruce Ovbiagele
BACKGROUND: Enhancing detection of undiagnosed atrial fibrillation (AF) in hospitalized patients with a recent ischemic stroke is important because of the treatment implications; especially since presence of paroxysmal AF may not be picked up in a single 12-lead electrocardiogram (ECG) test. While several trials have shown improved detection of AF with prolonged ECG monitoring, this strategy is associated with relatively high cost, labor intensity, and patient inconvenience, thereby making it challenging to routinely implement in all hospitals...
June 2017: Contemporary Clinical Trials Communications
https://www.readbyqxmd.com/read/29075576/cost-benefits-of-rapid-recanalization-using-intraarterial-thrombectomy
#14
Hye Seon Jeong, Jong Wook Shin, Hyon-Jo Kwon, Hyeon-Song Koh, Hae-Sung Nam, Hee Seon Yu, Na Young Yoon, Jei Kim
OBJECTIVES: Thrombolytic therapy is associated with favorable clinical outcomes after successful and rapid recanalization in patients with acute ischemic stroke. This study aimed to evaluate the cost benefits and clinical outcomes at 1 year after intraarterial thrombectomy (IAT) by the rapidity of the successful recanalization. MATERIALS & METHODS: Clinical outcomes of and medical costs incurred by 230 patients with acute ischemic stroke who underwent IAT were compared by the rapidity from symptom onset to successful recanalization (2b/3 thrombolysis in cerebral infarction grade): ≤6-hr (n = 143), >6-hr (n = 31), and no-recanalization (n = 56)...
October 2017: Brain and Behavior
https://www.readbyqxmd.com/read/29025039/rehabilitative-post-acute-care-for-stroke-patients-delivered-by-per-diem-payment-system-in-different-hospitalization-paths-a-taiwan-pilot-study
#15
Chung-Yuan Wang, Yu-Ren Chen, Jia-Pei Hong, Chih-Chun Chan, Long-Chung Chang, Hon-Yi Shi
Objective: To explore how post-acute care (PAC) for stroke patients delivered by per-diem payment system in varying hospitalization paths affects medical care utilization and functional status. Design, setting and patients: A longitudinal prospective cohort study of 181 acute stroke patients in a southern Taiwan hospital and patients were separated into two groups: patients transferred from regional hospitals (group 1) and patients referred from medical centers (group 2)...
August 14, 2017: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29018137/incidence-and-outcomes-of-myocardial-infarction-in-patients-admitted-with-acute-ischemic-stroke
#16
Fahad Alqahtani, Sami Aljohani, Abdul Tarabishy, Tatiana Busu, Amelia Adcock, Mohamad Alkhouli
BACKGROUND AND PURPOSE: Data on the incidence and outcomes of acute myocardial infarction (AMI) complicating acute ischemic stroke (AIS) are limited. We aim to evaluate the incidence, treatment patterns, and outcomes of AMI in patients with AIS using a nationwide database. METHODS: The National Inpatient Sample was used to identify patient with AIS between 2003 and 2014. Trends of incidence of AMI and its associated in-hospital mortality were evaluated. Univariate and multivariate logistic regressions were used to evaluate predictors of AMI...
November 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28991682/potential-role-of-tele-rehabilitation-to-address-barriers-to-implementation-of-physical-therapy-among-west-african-stroke-survivors-a-cross-sectional-survey
#17
Fred S Sarfo, Sheila Adamu, Dominic Awuah, Osei Sarfo-Kantanka, Bruce Ovbiagele
BACKGROUND: The greatest burden from stroke-related disability is borne by Low-and-Middle Income countries (LMICs) where access to rehabilitation after stroke is severely challenged. Tele-rehabilitation could be a viable avenue to address unmet rehabilitation needs in LMICs. OBJECTIVES: To assess the burden of post-stroke physical deficits, rates of utilization of physiotherapy services, and perceptions of tele-rehabilitation among recent Ghanaian stroke survivors...
October 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28987764/comparing-the-effects-of-adapting-to-a-weight-on-one-leg-during-treadmill-and-overground-walking-a-pilot-study
#18
Gabriela Lopes Gama, Douglas N Savin, Taylor Keenan, Sandy McCombe Waller, Jill Whitall
BACKGROUND: Locomotor adaptation has been suggested as a way to improve gait symmetry in individuals post-stroke. Most perturbation methods utilize costly, specialized equipment. The use of a unilateral leg weight may provide a low cost, clinically translatable alternative. Furthermore, previous studies have suggested that adaptation context may affect movement outcomes. The purpose of this study was to assess the ability of a unilaterally applied ankle weight to drive locomotor adaptation and determine the effect of context (treadmill versus overground) in young, non-disabled participants...
September 23, 2017: Gait & Posture
https://www.readbyqxmd.com/read/28983441/high-value-care-in-the-evaluation-of-stroke
#19
Prakrity Urja, Eric H Nippoldt, Virginia Barak, Carrie Valenta
Value-based care emphasizes achieving the greatest overall health benefit for every dollar spent. We present an interesting case of stroke, which made us consider how frequently health care providers are utilizing value-based care. A 73-year-old Caucasian, who was initially admitted for a hypertensive emergency, was transferred to our facility for worsening slurring of speech and left-sided weakness. The patient had an extensive chronic cerebrovascular disease, including multiple embolic type strokes, mainly in the distribution of the right temporal-occipital cerebral artery and transient ischemic attacks (TIAs)...
August 1, 2017: Curēus
https://www.readbyqxmd.com/read/28964382/emergency-department-hospital-inpatient-and-mortality-burden-of-atrial-fibrillation-in-the-united-states-2006-to-2014
#20
MULTICENTER STUDY
Sandra L Jackson, Xin Tong, Xiaoping Yin, Mary G George, Matthew D Ritchey
The prevalence of atrial fibrillation (AF) is increasing in the United States as the population ages, but national surveillance is lacking. This cross-sectional study (2006 to 2014) analyzed data from the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample, the National (Nationwide) Inpatient Sample, and the National Vital Statistics System. Event totals were estimated independently for emergency department (ED) visits, hospitalizations, and mortality, and then collectively after applying criteria to identify mutually exclusive events...
December 1, 2017: American Journal of Cardiology
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