An EHR-based Platform To Facilitate Outcomes and Research Methods in Cerebrovascular Diseases

Study Overview
=================
Brief Summary
-----------------
In this protocol, the investigators present methods and preliminary results from the PLATFORM-CVD Study, an EHR-based multicenter cohort. This study will focus on assessing the distribution of major cerebrovascular diseases, determining the risk factors associated with disease incidence and worse in-hospital outcomes, as well as describing the quality of care. Data from this cohort will be used to develop suitable prediction models for cerebrovascular diseases using real-world data and to understand how outcomes for cerebrovascular diseases would change with quality improvement interventions.

Detailed Description
-----------------
Adherence to healthcare quality measures is needed to reduce the burden of cerebrovascular disease and improve clinical outcomes. Electronic health records (EHRs) can facilitate the standardization of care provision and the improvement of disease prediction and prevention. Although the EHRs in clinical settings are increasingly prevalent in China, they are rarely used for healthcare research. the investigators aimed to conduct an EHR-based registry study to improve the healthcare and outcomes for cerebrovascular diseases. Twenty-four hospitals were enrolled in the PLATFORM-CVD Study in January 2018. Data collection began on February 1st, 2019. Historical data from January 2017 are abstracted first and prospective data are continuously reported until May 20th, 2020. Data were abstracted from the medical records, including hospital information system, laboratory information management system, and picture archiving and communication systems by an extract-transform-load tool. The EHR system included diagnostic information for cerebral infarctions (I63), nontraumatic intracerebral hemorrhages (I61), nontraumatic subarachnoid hemorrhages (I60), transient cerebral ischemic attacks and related syndromes (G45), intracranial and intraspinal phlebitis and thrombophlebitis (G08), vascular dementia (F01), and other aneurysms (I72). The quality of stroke care was assessed by 21 evidence-based performance measures. In-hospital outcomes were calculated including mortality, length of stay, and costs. The PLATFORM-CVD Study leverages EHRs to better understand incident cerebrovascular diseases in China. Data from this cohort will serve as a unique platform for quality assessment and improvement for acute treatment and secondary prevention of cerebrovascular diseases, as well as in-hospital outcome risk predictions and health economic evaluations.

Official Title
-----------------
A Platform for Linking and Assessing To Facilitate Outcomes and Research Methods in CerebroVascular Diseases Using Electronic Health Records (PLATFORM-CVD)

Conditions
-----------------
Stroke, Cerebrovascular Diseases, Cerebral Infarction, Cerebral Hemorrhage, Transient Ischemic Attack, Subarachnoid Hemorrhage

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients were included in the registry if they were hospitalized with a primary diagnose of： cerebral infarction (I63) nontraumatic intracerebral hemorrhage (I61) nontraumatic subarachnoid hemorrhage (I60) transient cerebral ischemic attack and related syndromes (G45) intracranial and intraspinal phlebitis and thrombophlebitis (G08) vascular dementia (F01) other aneurysms (I72) Exclusion Criteria: Patients diagnosed with other diseases.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| In-hospital mortality | Patients who died during hospitalization due to cerebrovascular diseases | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Length of stay at hospital | The total days for a patients with cerebrovascular diseases at hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Costs | The total costs for a patients with cerebrovascular diseases at hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of antiplatelet medication use | Rate of antiplatelet therapy during hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of dual antiplatelet medication use for non-disabling IS and TIA events | Rate of aspirin and clopidogrel therapy for ischemic cerebrovascular diseases (IS or TIA) during hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of DVT prophylaxis ≤ 48 hours | Patients at risk for DVT (non-ambulatory) who received DVT prophylaxis by end of hospital 48 hours, including pneumatic compression, warfarin sodium, and novel oral anticoagulant | 48 hours within hospitalization | 
| Cerebrovascular assessment ≤ seven days | Cerebrovascular assessment (TCD, IVUS, brain CT or MR scan) within seven days of hospitalization | 7 days within hospitalization | 
| Statin therapy for LDL ≥100 mg/dL during hospitalization | Lipid lowering agent prescribed during hospitalization if LDL ≥ 100 mg/dL, if patient treated with lipid lowering agent prior to admission, or LDL not documented | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of anticoagulation medication use for atrial fibrillation during hospitalization | Anticoagulation prescribed during hospitalization in patients with documented atrial fibrillation | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of antithrombotic medication prescribtion at discharge | Antithrombotic therapy prescribed at discharge, including antiplatelet or anticoagulant therapy | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of antihypertensive medication prescribtion for patients with hypertension at discharge | Antihypertension medication prescribed at discharge for patients with history of hypertension disease or hypertension disease documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of statin prescribtion for low-density lipoprotein≥100 mg/dL at discharge | Lipid lowering agent prescribed at discharge if LDL ≥ 100 mg/dL, if patient treated with lipid lowering agent prior to admission, or LDL not documented | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of hypoglycaemia medication prescribtion for diabetes mellitus at discharge | Hypoglycemic medication prescribed at discharge for patients with history of diabetes mellitus or diabetes mellitus documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of anticoagulation medication prescribtion for atrial fibrillation at discharge | Anticoagulation prescribed at discharge in patients with documented atrial fibrillation | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of thrombolytic therapy | Intravenous r-tPA in IS patients | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of thrombectomy therapy | Thrombectomy therapy for IS patients | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of DVT prophylaxis ≤ 48 hours for ICH | Patients with ICH at risk for DVT (non-ambulatory) who received DVT prophylaxis by end of hospital 48 hours, including pneumatic compression. | 48 hours within hospitalization | 
| Rate of antihypertensive medicine use for ICH patients with hypertension at discharge | Antihypertension medication prescribed at discharge for ICH patients with history of hypertension disease or hypertension disease documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of hypoglycemia medication use for ICH patients with diabetes mellitus at discharge | Hypoglycemic medication prescribed at discharge for ICH patients with history of diabetes mellitus or diabetes mellitus documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of neurosurgery for ICH patients | Neurosurgery of ICH include removal of hematoma by craniotomy, aspiration of hematoma by drilling, decompressive craniectomy, ventriculocentesis and drainage, other removal of intracranial hematoma | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of DVT prophylaxis ≤ 48 hours for SAH | Patients with SAH at risk for DVT (non-ambulatory) who received DVT prophylaxis by end of hospital 48 hours, including pneumatic compression | 48 hours within hospitalization | 
| Rate of antihypertensive medicine use for SAH patients with hypertension at discharge | Antihypertension medication prescribed at discharge for SAN patients with history of hypertension disease or hypertension disease documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of hypoglycemia medication use for SAH patients with diabetes mellitus at discharge | Hypoglycemic medication prescribed at discharge for SAH patients with history of diabetes mellitus or diabetes mellitus documented during the hospitalization | From date of hospitalization until the date of discharge, assessed up to 90 days | 
| Rate of neurosurgery for SAH patients | Neurosurgery of SAH include aneurysm clipping, endovascular embolization of aneurysm, extraventricular shunt | From date of hospitalization until the date of discharge, assessed up to 90 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Healthcare Quality, Electronic Health Records, Cerebrovascular Diseases