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Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries

Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despit...

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Autores principales: Novarro-Escudero, Nelson, Moon, Yoon Ji, Olmedo, Argelis, Ferguson, Teresa, Caballero, Ileana, Onodera, Eduardo, Effio, Euclides, Klein, Lisa M., Zink, Elizabeth K., Johnson, Brenda, Urrutia, Victor C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415350/
https://www.ncbi.nlm.nih.gov/pubmed/34484099
http://dx.doi.org/10.3389/fneur.2021.684775
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author Novarro-Escudero, Nelson
Moon, Yoon Ji
Olmedo, Argelis
Ferguson, Teresa
Caballero, Ileana
Onodera, Eduardo
Effio, Euclides
Klein, Lisa M.
Zink, Elizabeth K.
Johnson, Brenda
Urrutia, Victor C.
author_facet Novarro-Escudero, Nelson
Moon, Yoon Ji
Olmedo, Argelis
Ferguson, Teresa
Caballero, Ileana
Onodera, Eduardo
Effio, Euclides
Klein, Lisa M.
Zink, Elizabeth K.
Johnson, Brenda
Urrutia, Victor C.
author_sort Novarro-Escudero, Nelson
collection PubMed
description Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation. Objectives: To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019. Methods: Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement. Results: A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT. Conclusions: We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program.
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spelling pubmed-84153502021-09-04 Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries Novarro-Escudero, Nelson Moon, Yoon Ji Olmedo, Argelis Ferguson, Teresa Caballero, Ileana Onodera, Eduardo Effio, Euclides Klein, Lisa M. Zink, Elizabeth K. Johnson, Brenda Urrutia, Victor C. Front Neurol Neurology Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation. Objectives: To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019. Methods: Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement. Results: A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT. Conclusions: We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program. Frontiers Media S.A. 2021-08-16 /pmc/articles/PMC8415350/ /pubmed/34484099 http://dx.doi.org/10.3389/fneur.2021.684775 Text en Copyright © 2021 Novarro-Escudero, Moon, Olmedo, Ferguson, Caballero, Onodera, Effio, Klein, Zink, Johnson and Urrutia. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Novarro-Escudero, Nelson
Moon, Yoon Ji
Olmedo, Argelis
Ferguson, Teresa
Caballero, Ileana
Onodera, Eduardo
Effio, Euclides
Klein, Lisa M.
Zink, Elizabeth K.
Johnson, Brenda
Urrutia, Victor C.
Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title_full Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title_fullStr Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title_full_unstemmed Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title_short Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
title_sort organization and implementation of a stroke center in panamá, a model for implementation of stroke centers in low and middle income countries
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415350/
https://www.ncbi.nlm.nih.gov/pubmed/34484099
http://dx.doi.org/10.3389/fneur.2021.684775
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