Impact of systems of care and blood pressure management on stroke outcomes

David J. Shulkin, Kay E. Jewell, A. W. Alexandrov, David B. Bernard, Gretchen M. Brophy, David C Hess, Janis Kohlbrenner, Sheryl Martin-Schild, Stephen A. Mayer, W. Frank Peacock, Adnan I. Qureshi, Gene Y. Sung, Alan Lyles

Research output: Contribution to journalArticle

Abstract

Stroke is the third leading cause of death in the United States and the leading cause of disability. Stroke patients' outcomes are strongly determined by how long they remain untreated ("time is brain"). The Joint Commission's adoption of stroke performance improvement measures combined with the Centers for Medicare and Medicaid's more recent adoption in October 2009 make a systems approach to improving stroke outcomes a higher priority. As hospitals establish local and regional stroke care systems to meet these performance measures, treatment of emergent high blood pressure (BP) is a major consideration to improve rapid triage and management of acute stroke patients. Intravenous thrombolysis with tissue plasminogen activator (tPA) is a critical quality of care component for acute ischemic stroke (AIS) treatment, but its administration is contingent on BP management. For patients with AIS who are potentially eligible for tPA and patients with intracerebral hemorrhage, timely, controlled BP may improve patient outcomes. Appropriate BP management, however, is still controversial given the heterogeneity of stroke subtypes, the varying attributes of candidate antihypertensive agents, and both local and central hemodynamics. Additionally, organizational delivery system factors may be suboptimal at some hospitals. Under current hospital stroke performance measures, payment mechanisms, and emergency department throughput measures, the impact of BP management may become transparent to patients and payers, and have important consequences for hospital-derived stroke outcomes.

Original languageEnglish (US)
Pages (from-to)267-275
Number of pages9
JournalPopulation Health Management
Volume14
Issue number6
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

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Stroke
Blood Pressure
Tissue Plasminogen Activator
Quality of Health Care
Triage
Medicaid
Cerebral Hemorrhage
Critical Care
Medicare
Systems Analysis
Antihypertensive Agents
Hospital Emergency Service
Cause of Death
Joints
Hemodynamics
Hypertension
Brain
Therapeutics

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Shulkin, D. J., Jewell, K. E., Alexandrov, A. W., Bernard, D. B., Brophy, G. M., Hess, D. C., ... Lyles, A. (2011). Impact of systems of care and blood pressure management on stroke outcomes. Population Health Management, 14(6), 267-275. https://doi.org/10.1089/pop.2010.0068

Impact of systems of care and blood pressure management on stroke outcomes. / Shulkin, David J.; Jewell, Kay E.; Alexandrov, A. W.; Bernard, David B.; Brophy, Gretchen M.; Hess, David C; Kohlbrenner, Janis; Martin-Schild, Sheryl; Mayer, Stephen A.; Peacock, W. Frank; Qureshi, Adnan I.; Sung, Gene Y.; Lyles, Alan.

In: Population Health Management, Vol. 14, No. 6, 01.12.2011, p. 267-275.

Research output: Contribution to journalArticle

Shulkin, DJ, Jewell, KE, Alexandrov, AW, Bernard, DB, Brophy, GM, Hess, DC, Kohlbrenner, J, Martin-Schild, S, Mayer, SA, Peacock, WF, Qureshi, AI, Sung, GY & Lyles, A 2011, 'Impact of systems of care and blood pressure management on stroke outcomes', Population Health Management, vol. 14, no. 6, pp. 267-275. https://doi.org/10.1089/pop.2010.0068
Shulkin, David J. ; Jewell, Kay E. ; Alexandrov, A. W. ; Bernard, David B. ; Brophy, Gretchen M. ; Hess, David C ; Kohlbrenner, Janis ; Martin-Schild, Sheryl ; Mayer, Stephen A. ; Peacock, W. Frank ; Qureshi, Adnan I. ; Sung, Gene Y. ; Lyles, Alan. / Impact of systems of care and blood pressure management on stroke outcomes. In: Population Health Management. 2011 ; Vol. 14, No. 6. pp. 267-275.
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