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.
journal_name
Popul Health Managjournal_title
Population health managementauthors
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 Adoi
10.1089/pop.2010.0068subject
Has Abstractpub_date
2011-12-01 00:00:00pages
267-75issue
6eissn
1942-7891issn
1942-7905journal_volume
14pub_type
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