title: Impact of Increased Early Statin Administration on Ischemic Stroke Outcomes: A Multicenter Electronic Medical Record Intervention.
abstract: Statin administration early in ischemic stroke may influence outcomes. Our aim was to determine the clinical impact of increasing statin administration early in ischemic stroke hospitalization.
  
  
  
  This is a retrospective analysis of a multicenter electronic medical record (EMR) intervention to increase early statin administration in ischemic stroke across all 20 hospitals of an integrated healthcare delivery system. A stroke EMR order set was modified from an "opt-in" to "opt-out" mode of statin ordering. Outcomes were mortality by 90 days, discharge disposition, and increase in stroke severity. We examined the relationship between intervention and outcome using autoregressive integrated moving average (ARIMA) time-series modeling. The EMR intervention increased both overall in-hospital statin administration (from 87.2% to 90.7%, P<0.001) and early statin administration (from 16.9% to 26.3%, P<0.001). ARIMA models showed a small increase in the rate of survival (difference in probability [Pdiff]=0.02, P=0.016) and discharge to home or rehabilitation facility (Pdiff=0.04, P=0.034) associated with the intervention. The increase in statin administration <8 hours was associated with much larger increases in survival (Pdiff=0.17, P=0.033) and rate of discharge to home or rehabilitation (Pdiff=0.29, P=0.011), as well as a decreased rate of neurological deterioration in-hospital (Pdiff=-0.14, P=0.026).
  
  
  
  A simple EMR change increased early statin administration in ischemic stroke and was associated with improved clinical outcomes. This is, to our knowledge, the first EMR intervention study to show that a modification of an electronic order set resulted in improved clinical outcomes.
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA Division of Research, Kaiser Permanente Northern California, Oakland, CA alexander.c.flint@kp.org.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Carol
authors.initials: C
authors.lastname: Conell
authors.affiliation: Department of Neurology, Kaiser Permanente, Walnut Creek, CA.
authors.forename: Jeff G
authors.initials: JG
authors.lastname: Klingman
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Department of Neurology, Weill Cornell Medical Center, New York, NY.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cullen
authors.affiliation: Department of Neuroscience, Kaiser Permanente, Redwood City, CA.
authors.forename: Bonnie S
authors.initials: BS
authors.lastname: Faigeles
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Steve
authors.initials: S
authors.lastname: Sidney
authors.affiliation: Dell Medical School, University of Texas, Austin, TX.
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D004334:Drug Administration Schedule; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D018697:Nootropic Agents / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018697:Nootropic Agents
keywords: electronic medical record intervention; ischemic stroke; order sets; outcome; statin intervention