Assessment of Home-Time after Acute Ischemic Stroke in Medicare Beneficiaries

Gregg C. Fonarow, Li Liang, Laine Thomas, Ying Xian, Jeffrey L. Saver, Eric E. Smith, Lee H. Schwamm, Eric D. Peterson, Adrian F. Hernandez, Pamela W. Duncan, Emily C. O'Brien, Cheryl Bushnell, Janet Prvu Bettger

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose-Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. Methods-Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index. Results-There were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70-82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2-7]) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52-86) days and 349 (IQR, 303-360) days and median mRS were 2 (IQR, 1-4) and 2 (IQR, 1-4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient,-0.731; P<0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 (c-index, 0.837). Similar findings were observed at 1 year. Conclusions-In a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.

Original languageEnglish (US)
Pages (from-to)836-842
Number of pages7
JournalStroke
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

Keywords

  • modified Rankin Scale
  • patient-centered outcomes research
  • skilled nursing facilities
  • stroke
  • survivors

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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