Hospital Variation in Home-Time after Acute Ischemic Stroke: Insights from the PROSPER Study (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research)

Emily C. O'Brien, Ying Xian, Haolin Xu, Jingjing Wu, Jeffrey L. Saver, Eric E. Smith, Lee H. Schwamm, Eric D. Peterson, Mathew J. Reeves, Deepak L. Bhatt, Lesley Maisch, Deidre Hannah, Brianna Lindholm, Daiwai Olson, Janet Prvu Bettger, Michael Pencina, Adrian F. Hernandez, Gregg C. Fonarow

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background and Purpose - Stroke survivors identify home-time as a high-priority outcome; there are limited data on factors influencing home-time and home-time variability among discharging hospitals. Methods - We ascertained home-time (ie, time alive out of a hospital, inpatient rehabilitation facility, or skilled nursing facility) at 90 days and 1-year post discharge by linking data from Get With The Guidelines-Stroke Registry patients (≥65 years) to Medicare claims. Using generalized linear mixed models, we estimated adjusted mean home-time for each hospital. Using linear regression, we examined associations between hospital characteristics and risk-adjusted home-time. Results - We linked 156 887 patients with ischemic stroke at 989 hospitals to Medicare claims (2007-2011). Hospital mean home-time varied with an overall unadjusted median of 59.5 days over the first 90 days and 270.2 days over the first year. Hospital factors associated with more home-time over 90 days included higher annual stroke admission volume (number of ischemic stroke admissions per year); South, West, or Midwest geographic regions (versus Northeast); and rural location; 1-year patterns were similar. Lowest home-time quartile patients (versus highest) were more likely to be older, black, women, and have more comorbidities and severe strokes. Home-time variation decreased after risk adjustment (interquartile range, 57.4-61.4 days over 90 days; 266.3-274.2 days over 1 year). In adjusted analyses, increasing annual stroke volume and rural location were associated with significantly more home-time. Conclusions - In older ischemic stroke survivors, home-time post discharge varies by hospital annual stroke volume, severity of case-mix, and region. In adjusted analyses, annual ischemic stroke admission volume and rural location were associated with more home-time post stroke.

Original languageEnglish (US)
Pages (from-to)2627-2633
Number of pages7
JournalStroke
Volume47
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • health services research
  • healthcare quality assessment
  • patient centered outcomes research
  • risk adjustment
  • stroke, acute

ASJC Scopus subject areas

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

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    O'Brien, E. C., Xian, Y., Xu, H., Wu, J., Saver, J. L., Smith, E. E., Schwamm, L. H., Peterson, E. D., Reeves, M. J., Bhatt, D. L., Maisch, L., Hannah, D., Lindholm, B., Olson, D., Prvu Bettger, J., Pencina, M., Hernandez, A. F., & Fonarow, G. C. (2016). Hospital Variation in Home-Time after Acute Ischemic Stroke: Insights from the PROSPER Study (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research). Stroke, 47(10), 2627-2633. https://doi.org/10.1161/STROKEAHA.116.013563