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Abstracts and presentations are embargoed for release at date and time of presentation or time of AHA/ASA news event. Information may not be released before then. Failure to honor embargo policies will result in the abstract being withdrawn and barred from presentation.
PosterSession Title: Poster Session II

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

Karen E Joynt, Deepak L Bhatt, Lee H Schwamm, Ying Xian, Paul A Heidenreich, Gregg C Fonarow, Eric E Smith, Maria V Grau-Sepulveda, Adrian F Hernandez
Circulation: Cardiovascular Quality and Outcomes. 2014;7:A266
Karen E Joynt
Brigham and Women's Hosp, Boston, MA
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Deepak L Bhatt
Brigham and Women's Hosp, Boston, MA
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Lee H Schwamm
Massachusetts General Hosp, Boston, MA
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Ying Xian
Duke Clinical Rsch Institute, Durham, NC
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Paul A Heidenreich
VA Palo Alto Med Cntr, Palo Alto, CA
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Gregg C Fonarow
UCLA, Los Angeles, CA
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Eric E Smith
Univ of Calgary, Calgary, Canada
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Maria V Grau-Sepulveda
Duke Clinical Rsch Institute, Durham, NC
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Adrian F Hernandez
Duke Clinical Rsch Institute, Durham, NC
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Abstract

Background: Electronic Health Records (EHRs) may be a key tool for improving the quality of healthcare. They may be particularly important for conditions such as ischemic stroke, in which guidelines are rapidly evolving and timely care of the patient is critical.

Methods: We used data from 1,236 hospitals participating in Get With The Guidelines-Stroke, representing 626,473 ischemic strokes between 2007 and 2010, and linked this with the American Hospital Association annual survey to characterize which study hospitals had an EHR. We conducted regression analyses to determine whether hospitals with an EHR demonstrated better performance on quality metrics, length of stay, discharge to home, and mortality.

Results: 511 hospitals had an EHR by the end of the study period. Stroke patients at hospitals with EHRs were younger, more often male and non-white, and had a lower burden of medical comorbidities. Hospitals with EHRs were larger, and more often teaching hospitals and stroke centers than hospitals without EHRs. In unadjusted analyses, patients at hospitals with EHRs were more likely to receive “all-or-none” care (87.9% versus 82.6%, p<0.001), and less likely to have a length of stay over 4 days (42.4% versus 43.9%, p<0.001). However, there were no differences in discharge to a site other than home (50.9% versus 51.1%, p=0.12) or in-hospital mortality (5.3% versus 5.2%, p=0.40). In multivariate analyses, after controlling for patient and hospital characteristics, the presence of an EHR was no longer associated with better quality care, and continued to have no association with clinical outcomes (Table).

Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.


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  • Electronic Health Records
  • Stroke
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  • Author Disclosures: K.E. Joynt: None. D.L. Bhatt: None. L.H. Schwamm: None. Y. Xian: None. P.A. Heidenreich: None. G.C. Fonarow: None. E.E. Smith: None. M.V. Grau-Sepulveda: None. A.F. Hernandez: None.

  • © 2014 by American Heart Association, Inc.
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July 2014, Volume 7, Issue Suppl 1
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    Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke
    Karen E Joynt, Deepak L Bhatt, Lee H Schwamm, Ying Xian, Paul A Heidenreich, Gregg C Fonarow, Eric E Smith, Maria V Grau-Sepulveda and Adrian F Hernandez
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:A266, originally published June 2, 2014

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    Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke
    Karen E Joynt, Deepak L Bhatt, Lee H Schwamm, Ying Xian, Paul A Heidenreich, Gregg C Fonarow, Eric E Smith, Maria V Grau-Sepulveda and Adrian F Hernandez
    Circulation: Cardiovascular Quality and Outcomes. 2014;7:A266, originally published June 2, 2014
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