TY - JOUR
T1 - Hospital Variation in Functional Recovery after Stroke
AU - Bettger, Janet Prvu
AU - Thomas, Laine
AU - Liang, Li
AU - Xian, Ying
AU - Bushnell, Cheryl D.
AU - Saver, Jeffrey L.
AU - Fonarow, Gregg C.
AU - Peterson, Eric D.
N1 - Funding Information:
This study was funded by the Patient-Centered Outcomes Research Institute (Project No. 130; principal investigator: J.P. Bettger). The AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) was supported by the Agency for Healthcare Research and Quality (U18HS016964) and unrestricted funds from Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. Get With The Guidelines-Stroke (GWTG-Stroke) is provided by the American Heart Association/American Stroke Association and has been funded in the past through support from Boehringer Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, Janseen Pharmaceutical Companies of Johnson and Johnson, and the AHA Pharmaceutical Roundtable.
Publisher Copyright:
© 2017 American Heart Association, Inc.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background - Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. Methods and Results - Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. Conclusions - One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.
AB - Background - Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. Methods and Results - Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. Conclusions - One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.
KW - health services research
KW - risk adjustment
KW - stroke
KW - survivors
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U2 - 10.1161/CIRCOUTCOMES.115.002391
DO - 10.1161/CIRCOUTCOMES.115.002391
M3 - Article
C2 - 28096203
AN - SCOPUS:85009951531
SN - 1941-7713
VL - 10
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 1
M1 - e002391
ER -