Kaiser Permanente Northern California Hospitals Honored for Stroke Care

The American Heart Association recognizes Kaiser Permanente's commitment to providing the most appropriate stroke treatment.

All Kaiser Permanente (No. 2 on the DiversityInc Top 50 Companies list) hospitals in Northern California received the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke Quality Achievement Awards and 20 hospitals earned a place on the Target: Stroke Honor Roll-Elite Plus, the organization's award for excellence in rapid stroke care.


The American Heart Association distinction recognizes each of the Target: Stroke Honor Roll-Elite Plus Kaiser Permanente Northern California hospitals for reaching an aggressive goal of achieving 85 percent or higher of all the Get With The Guidelines-Stroke achievement indicators for two or more consecutive years.

The award recognizes Kaiser Permanente's commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

"It's proven that getting treatment for stroke quickly is critical to survival and recovery," said Janet Liang, president, Kaiser Permanente Northern California. "In our Northern California hospitals, we are more than twice as fast as the national average in delivering the clot-dissolving medication for new stroke patients. That's why this recognition is so meaningful to us—it represents better outcomes and lives saved."

American Heart Association and American Stroke Association guidelines recommend "door-to-needle" times of 60 minutes or less for intravenous r-tPA, the medication that dissolves the stroke-causing clot and restores blood flow to the brain. However, studies show that less than 30 percent of acute ischemic stroke patients in the United States are currently being treated within this window.

Telestroke cart equipped video camera enables access to a specially-trained neurologist even when they are many miles away.

A recently published Kaiser Permanente study in the journal Stroke looked at the adoption of a telemedicine program and standardized treatment protocol for stroke care across Kaiser Permanente's 21 Northern California hospitals and found that the average treatment time for intravenous r-tPA was 34 minutes—more than twice as fast as the national average.

"What differentiates our program is our integrated approach to care delivery – as we leveraged with this nation-leading stroke care. Our model allows for the quick spread of cutting-edge innovations across all our hospitals," explained Richard S. Isaacs, MD, executive director and CEO of The Permanente Medical Group. "We have also widely adopted new technology, like telemedicine. This means our patients have access to highly-trained specialists regardless of their physical location."

All Kaiser Permanente emergency departments in Northern California are equipped with telestroke carts, which include a video camera and access to scans and test results. This technology enables access to a dedicated, specially-trained neurologist who conducts a patient's neurologic physical exam remotely via video.

The awards were presented to representatives of each of the Kaiser Permanente medical centers during the International Stroke Conference in Los Angeles on Jan. 25.

For more information about recognizing the signs of stroke, visit kp.org/stroke.

Learn about career opportunities at Kaiser Permanente

Kaiser Permanente Researchers Develop New Models for Predicting Suicide Risk

Approach may offer value to health systems and clinicians in targeting interventions to prevent suicide

Originally Published by Kaiser Permanente.

Combining data from electronic health records with results from standardized depression questionnaires better predicts suicide risk in the 90 days following either mental health specialty or primary care outpatient visits, reports a team from the Mental Health Research Network, led by Kaiser Permanente research scientists.

The study, "Predicting Suicide Attempts and Suicide Death Following Outpatient Visits Using Electronic Health Records," conducted in five Kaiser Permanente regions (Colorado, Hawaii, Oregon, California and Washington), the Henry Ford Health System in Detroit, and the HealthPartners Institute in Minneapolis, was published today in the American Journal of Psychiatry.

Combining a variety of information from the past five years of people's electronic health records and answers to questionnaires, the new models predicted suicide risk more accurately than before, according to the authors. The strongest predictors include prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency room care, and scores on a standardized depression questionnaire.

Dr. Simon shares what inspired him to study mental health.

"We demonstrated that we can use electronic health record data in combination with other tools to accurately identify people at high risk for suicide attempt or suicide death," said first author Gregory E. Simon, MD, MPH, a Kaiser Permanente psychiatrist in Washington and a senior investigator at Kaiser Permanente Washington Health Research Institute.

In the 90 days following an office visit:

  • Suicide attempts and deaths among patients whose visits were in the highest 1 percent of predicted risk were 200 times more common than among those in the bottom half of predicted risk.
  • Patients with mental health specialty visits who had risk scores in the top 5 percent accounted for 43 percent of suicide attempts and 48 percent of suicide deaths.
  • Patients with primary care visits who had scores in the top 5 percent accounted for 48 percent of suicide attempts and 43 percent of suicide deaths.

This study builds on previous models in other health systems that used fewer potential predictors from patients' records. Using those models, people in the top 5 percent of risk accounted for only a quarter to a third of subsequent suicide attempts and deaths. More traditional suicide risk assessment, which relies on questionnaires or clinical interviews only, is even less accurate.

The new study involved seven large health systems serving a combined population of 8 million people in nine states. The research team examined almost 20 million visits by nearly 3 million people age 13 or older, including about 10.3 million mental health specialty visits and about 9.7 million primary care visits with mental health diagnoses. The researchers deleted information that could help identify individuals.

"It would be fair to say that the health systems in the Mental Health Research Network, which integrate care and coverage, are the best in the country for implementing suicide prevention programs," Dr. Simon said. "But we know we could do better. So several of our health systems, including Kaiser Permanente, are working to integrate prediction models into our existing processes for identifying and addressing suicide risk."

Suicide rates are increasing, with suicide accounting for nearly 45,000 deaths in the United States in 2016; 25 percent more than in 2000, according to the National Center for Health Statistics.

Other health systems can replicate this approach to risk stratification, according to Dr. Simon. Better prediction of suicide risk can inform decisions by health care providers and health systems. Such decisions include how often to follow up with patients, refer them for intensive treatment, reach out to them after missed or canceled appointments — and whether to help them create a personal safety plan and counsel them about reducing access to means of self-harm.