TY - JOUR
T1 - Hospital Variation in Home-Time after Acute Ischemic Stroke
T2 - Insights from the PROSPER Study (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research)
AU - O'Brien, Emily C.
AU - Xian, Ying
AU - Xu, Haolin
AU - Wu, Jingjing
AU - Saver, Jeffrey L.
AU - Smith, Eric E.
AU - Schwamm, Lee H.
AU - Peterson, Eric D.
AU - Reeves, Mathew J.
AU - Bhatt, Deepak L.
AU - Maisch, Lesley
AU - Hannah, Deidre
AU - Lindholm, Brianna
AU - Olson, Daiwai
AU - Prvu Bettger, Janet
AU - Pencina, Michael
AU - Hernandez, Adrian F.
AU - Fonarow, Gregg C.
N1 - Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - health services research
KW - healthcare quality assessment
KW - patient centered outcomes research
KW - risk adjustment
KW - stroke, acute
UR - http://www.scopus.com/inward/record.url?scp=84987600792&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84987600792&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.116.013563
DO - 10.1161/STROKEAHA.116.013563
M3 - Article
C2 - 27625383
AN - SCOPUS:84987600792
SN - 0039-2499
VL - 47
SP - 2627
EP - 2633
JO - Stroke
JF - Stroke
IS - 10
ER -