title: Electronic Stroke CarePath: Integrated Approach to Stroke Care.
abstract: We describe the development, implementation, and outcomes of the first 2 years of the Electronic Stroke CarePath, an initiative developed for management of ischemic stroke patients in an effort to improve efficiency and quality of care for patients. The CarePath consists of care pathways for ischemic stroke that are integrated within the electronic health record. Patient-reported outcomes are collected using an external software platform. Documentation tools, order sets, and clinical decision support were designed to improve efficiency, optimize process measure adherence, and produce clinical data as a byproduct of care that are available for future analyses. Inpatient mortality and length of stay were compared before and after CarePath implementation in ischemic stroke patients after adjustment for case-mix. Postdischarge functional outcomes of patients with ischemic stroke were compared between the first 3 months of rollout and remainder of the study period. From January 2011 to December 2012, there were 1106 patients with ischemic stroke on the CarePath. There was a decline in inpatient mortality in patients with ischemic stroke, but not in control patients with intracerebral or subarachnoid hemorrhage. Completion rate of patient-reported questionnaires at postdischarge stroke follow-up was 72.9%. There was a trend toward improved functional outcomes at follow-up with CarePath implementation. Implementation of the Electronic Stroke CarePath is feasible and may be associated with a benefit in multiple different outcomes after ischemic stroke. This approach may be an important strategy for optimizing stroke care in the future.
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.). katzani@ccf.org.
authors.forename: Irene L
authors.initials: IL
authors.lastname: Katzan
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Youran
authors.initials: Y
authors.lastname: Fan
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Micheal
authors.initials: M
authors.lastname: Speck
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Johanna
authors.initials: J
authors.lastname: Morton
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Lauren
authors.initials: L
authors.lastname: Fromwiller
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: John
authors.initials: J
authors.lastname: Urchek
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Griffith
authors.affiliation: From the Center for Outcomes Research and Evaluation, Neurological Institute (I.L.K., Y.F., S.D.G., M.M.), Information Technology Division, Clinical Systems Office (I.L.K., L.F., J.U.), Cerebrovascular Center, Neurological Institute (I.L.K., K.U., M.M.), and Lerner Research Institute, Quantitative Health Sciences (Y.F., S.D.G.), Cleveland Clinic, OH; and Speck Technologies, Cleveland, OH (M.S.).
authors.forename: Michael
authors.initials: M
authors.lastname: Modic
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D019468:Disease Management; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: clinical pathways; medical informatics; quality of health care; stroke