Improving Stroke Outcomes for African Americans

改善非裔美国人的中风结果

• 批准号: 8644139
• 负责人: Monika M Safford
• 金额: $ 18.45万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8644139
• 关键词: Acute; Address; Adherence; Adult; African American; Aging; Area; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Chronic Care; Chronic Kidney Failure; Clinical Trials; Cohort Studies; Complex; Data; Diabetes Mellitus; Effectiveness; Event; Fever; Goals; Guidelines; Health Services; Healthcare; Hospitalization; Hospitals; Hypoxia; Incidence; Individual; Inpatients; Institute of Medicine (U.S.); Ischemic Stroke; Joint Commission on Accreditation of Healthcare Organizations; Joints; Lead; Left; Link; Medical; Minority; Myocardial Infarction; Outcome; Patients; Performance; Phase; Population; Process; Public Health; Quality Indicator; Quality of Care; Quality of life; Reasons for Geographic And Racial Differences in Stroke; Recurrence; Relative (related person); Reporting; Research; Stroke; Survivors; Testing; Time; United States Centers for Medicare and Medicaid Services; Variant; Work; acute stroke; base; compare effectiveness; cost effectiveness; disability; geographic difference; hazard; health care service utilization; health disparity; improved; minority health; mortality; older patient; programs; racial difference; response

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.

中风是美国第三大死亡原因，也是导致成人长期残疾的主要原因之一，对非裔美国人影响很大。由于 90% 的中风幸存者存在功能障碍，因此改善中风结果是一个重大的公共卫生问题。 CMS 和联合委员会等机构已经实施了包括质量指标 (QI) 在内的绩效计划，理想情况下应根据对中风相关结果的影响来选择质量指标，但目前此类证据很少。医学研究所表示“关于医疗保健中有效方法的公正、可靠的信息对于减少 使用医疗保健服务的地理差异，并提高质量。”我们建议系统地 研究与急性缺血性中风 (AIS) 护理相关的 Qls 及其与治疗结果的关系 心血管疾病 [CVD] 死亡率、CVD 事件和功能独立性。总体目标是 开发一套“最佳”AIS 护理 Qls，最大限度地提高患者整体的长期结果 对于特定的患者群体，例如非裔美国人和患有慢性肾病的 AIS 患者 慢性肾病（CKD）或糖尿病，这两种疾病在非裔美国人中更为常见。我们的目标是 1）检查 AIS 管理指南一致过程的变化，假设指南一致护理 会因患者、医院和地区因素而异，并且遵守 CMS Qls，但不遵守其他潜在 Qls 将比 2003-12 年有所改善； 2）检查AIS管理过程和结果之间的关联， 包括 CMS 数据>70% 的增量和相对有效性以及成本效益。 假设指南一致护理与较低的院内并发症和死亡率相关， 一年后，初次 AIS 住院期间符合指南的住院护理与 具有较低的复发性中风、心肌梗死 (MI)、CVD 死亡率和较高的功能独立性； 3） 检查 AIS 管理过程与 CKD 患者的 AIS 结局之间的关联，或 糖尿病，假设 CKD 或糖尿病患者接受的符合指南的护理少于 其他人，并且接受符合指南的护理的 CKD 和糖尿病患者将会有更好的结果 与其他患者相比，但优化 CKD 和糖尿病患者生活质量的 Qls 集合会有所不同 与 AIS 患者的总体情况相同。该研究将包括 AIS 护理流程的正式图表抽象 在 1200 名 REGARDS 受试者中进行调查，并将使用有关医院特征的公开数据以及 CMS 数据。