TY - JOUR
T1 - Is Risk-Standardized In-Hospital Stroke Mortality an Adequate Proxy for Risk-Standardized 30-Day Stroke Mortality Data?
T2 - Findings from Get with the Guidelines-Stroke
AU - Reeves, Mathew J.
AU - Fonarow, Gregg C.
AU - Xu, Haolin
AU - Matsouaka, Roland A.
AU - Xian, Ying
AU - Saver, Jeffrey
AU - Schwamm, Lee
AU - Smith, Eric E.
N1 - Funding Information:
The Get With The Guidelines–Stroke (GWTG–Stroke) program is provided by the American Heart Association (AHA)/American Stroke Association. The GWTG–Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG–Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership, and the AHA Pharmaceutical Roundtable.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background-Hospital profiling is typically undertaken using risk-standardized 30-day mortality, but obtaining these data for hospitals can be difficult. We sought to determine whether risk-standardized in-hospital mortality could serve as an adequate proxy for risk-standardized 30-day mortality data for the purposes of identifying outlier hospitals. Methods and Results-Acute ischemic stroke cases entered into GWTG (Get With The Guidelines)-Stroke between 2003 and 2013 were linked to fee-for-service Medicare files to obtain 30-day mortality. Risk-standardized mortality rates (RSMR) for in-hospital and 30-day mortality were generated using previously developed risk score models, and the proportion of hospitals classified as statistical outliers compared. We also assessed the impact of using the combined outcome of in-hospital mortality or discharge to hospice. A total of 535 332 ischemic stroke patients from 1494 GWTG-Stroke hospitals were included; mean age was 80 years, 59% female, and 19% nonwhite. At the hospital level, mean in-hospital RSMRs and 30-day RSMRs were 6.0% and 14.6%, respectively, but the correlation between the 2 was modest (r=0.53). Overall agreement in the designation of outlier hospitals between in-hospital and 30-day RSMRs was 78%, but chance-corrected agreement was only fair (κ=0.29). However, when using the combined outcome of in-hospital mortality or discharge to hospice (risk-standardized mean =11.8%), the correlation with 30-day RSMR was much stronger (r= 0.83) and outlier agreement improved substantially (κ=0.60). Conclusions-When used to identify outlier hospitals with high or low mortality, the agreement between risk-standardized in-hospital mortality and 30-day mortality was modest. However, the combined outcome of in-hospital mortality or discharge to hospice showed much better agreement with 30-day mortality. This composite outcome could serve as a proxy for 30-day mortality when used to identify low-or high-performing hospitals.
AB - Background-Hospital profiling is typically undertaken using risk-standardized 30-day mortality, but obtaining these data for hospitals can be difficult. We sought to determine whether risk-standardized in-hospital mortality could serve as an adequate proxy for risk-standardized 30-day mortality data for the purposes of identifying outlier hospitals. Methods and Results-Acute ischemic stroke cases entered into GWTG (Get With The Guidelines)-Stroke between 2003 and 2013 were linked to fee-for-service Medicare files to obtain 30-day mortality. Risk-standardized mortality rates (RSMR) for in-hospital and 30-day mortality were generated using previously developed risk score models, and the proportion of hospitals classified as statistical outliers compared. We also assessed the impact of using the combined outcome of in-hospital mortality or discharge to hospice. A total of 535 332 ischemic stroke patients from 1494 GWTG-Stroke hospitals were included; mean age was 80 years, 59% female, and 19% nonwhite. At the hospital level, mean in-hospital RSMRs and 30-day RSMRs were 6.0% and 14.6%, respectively, but the correlation between the 2 was modest (r=0.53). Overall agreement in the designation of outlier hospitals between in-hospital and 30-day RSMRs was 78%, but chance-corrected agreement was only fair (κ=0.29). However, when using the combined outcome of in-hospital mortality or discharge to hospice (risk-standardized mean =11.8%), the correlation with 30-day RSMR was much stronger (r= 0.83) and outlier agreement improved substantially (κ=0.60). Conclusions-When used to identify outlier hospitals with high or low mortality, the agreement between risk-standardized in-hospital mortality and 30-day mortality was modest. However, the combined outcome of in-hospital mortality or discharge to hospice showed much better agreement with 30-day mortality. This composite outcome could serve as a proxy for 30-day mortality when used to identify low-or high-performing hospitals.
KW - Medicare
KW - hospital profiling
KW - mortality/survival
KW - registry
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85040788156&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040788156&partnerID=8YFLogxK
U2 - 10.1161/CIRCOUTCOMES.117.003748
DO - 10.1161/CIRCOUTCOMES.117.003748
M3 - Article
C2 - 29021333
AN - SCOPUS:85040788156
SN - 1941-7713
VL - 10
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 10
ER -