Center for Health Care Research & Policy

Stroke Outcomes Research Program (SORP)

Director

Irene Katzan, M.D., M.S.

Mission

To conduct research that improves access, quality, and outcomes of care for persons with stroke, reduces risk for stroke, and eliminates disparities in care by race and socioeconomic status; and, to train individuals whose work will accomplish these goals.

Background

Stroke is the leading cause of major disability in the United States. It also is the second leading cause of death worldwide and the third-leading cause of death in the United States. The impact of stroke disproportionately affects minorities and the elderly, and it will increase as the population ages. In Cuyahoga County alone, over 3000 residents are hospitalized annually for stroke; of these, almost 1000 die each year. Most patients who are at increased risk for stroke, and most stroke victims, are cared for in community settings. These features of stroke care motivate community-wide efforts to reduce stroke risk, improve care for acute stroke victims, and improve access and quality of follow-up care among stroke survivors. Modifiable risk factors for stroke include obesity, tobacco use, high blood pressure, abnormal blood lipids, and diabetes mellitus.

The Stroke Outcomes Research Program brings together researchers from multiple disciplines to allow comprehensive evaluation of availability, delivery, and outcomes of health care for stroke and those at increased risk for stroke. The Program spans hospitals and health care systems across Northeast Ohio.

The main focus of SORP is the assessment of community-based stroke prevention, management, and outcomes in northeastern Ohio. Areas of research concentration include:

Assessment of Current Status of Stroke Management in the Community Setting
Although most studies of stroke care come from academic medical centers, the majority of stroke patients are cared for in community setting. Researchers in SORP are working with the American Heart Association's Operation Stroke initiative and other researchers from the University of Cincinnati (as part of the CDC- funded Ohio Prototype for the Paul Coverdell National Acute Stroke Registry) to evaluate and improve the current status of stroke management in northeastern Ohio.

Evaluation of Medical Complications After Stroke
Medical complications occur frequently after stroke and have a significant impact on outcomes, including mortality, morbidity, readmission rates, and costs of care. SORP researchers are evaluating the predictors, impact, and methods to prevent these complications. Seventeen hospitals in the Northeast Ohio region are participating in an NIH/NINDS-funded study to evaluate pneumonia occurring in patients hospitalized for stroke.

End-of-Life Decisions in Stroke Patients
Patients hospitalized for stroke and their families must make difficult decisions on aggressivity of care. Approximately one-fifth of stroke patients choose "Do Not Resuscitate" status within their first two days of hospitalization. The factors affecting these decisions, and their subsequent impact on stroke care, are areas of active research.

Assessment of Outcome Measures After Stroke
Stroke is the leading cause of major disability in the United States. Many stroke survivors are unable to resume their previous lifestyle or employment. Measuring the impact of stroke on the lives of survivors is critical to assess the effect of interventions and care on stroke outcomes. SORP investigators are developing new methods to measure functional outcomes after stroke. These include statistical modeling to develop new measurement systems as well as modification of existing measures.

Reducing Risks of Stroke
Modifiable risk factors for stroke include obesity, tobacco use, high blood pressure, abnormal blood lipids, and diabetes mellitus, most of which disproportionately affect minority groups, especially African Americans. Improving the profiles of patients at increased risk, and reducing disparities in care for these patients, is vital for reducing the incidence and impact of stroke. SORP investigators are developing multiple approaches for reducing stroke risks, including disease management programs and innovative region-wide methods that use established electronic medical record (EMR) systems.

Meet the Members of SORP

Irene Katzan MD, MS, Director
Center for Health Care Research & Policy, MetroHealth Medical Center
Department of Neurology, Cleveland Clinic Foundation
Randall Cebul MD
Director, Center for Health Care Research & Policy
MetroHealth Medical Center
Anthony Furlan MD
Director, Cerebrovascular Institute
Cleveland Clinic Foundation
Dennis M. Landis MD
Chairman, Department of Neurology
University Hospitals of Cleveland
Joseph Hanna MD
Chairman, Department of Neurology
MetroHealth Medical Center
Patrick Murray MD, MS
Center for Health Care Research & Policy
MetroHealth Medical Center
Gwendolyn Lynch MD
Department of Neurology
University Hospitals of Cleveland
Thomas Love PhD
Director, Biostatistics Unit
Center for Health Care Research & Policy
MetroHealth Medical Center
Alice Liskay RN
Clinical Research Coordinator
Department of Neurology
MetroHealth Medical Center

Recent Articles from SORP Researchers

Katzan IL, Cebul RD, Husak SH, Dawson NV, Baker DW. The Effect of Pneumonia on Mortality Among Patients Hospitalized for Acute Stroke. Neurology 2003;60:620-625.

Katzan IL, Hammer MD, Furlan AJ, Hixson ED, Nadzam DM. Quality Improvement and Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: A Cleveland Update. Stroke 2003;34:799-800.

Katzan IL, Graber TM, Furlan TM, Sundararajan S, Sila CA, Houser G, Landis DM, for Cuyahoga County Operation Stroke. Cuyahoga County Operation Stroke Speed of Emergency Department Evaluation and Compliance With National Institutes of Neurological Disorders and Stroke Time Targets. Stroke 2003;34.

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