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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).

Publication ,  Journal Article
O'Brien, EC; Xian, Y; Xu, H; Wu, J; Saver, JL; Smith, EE; Schwamm, LH; Peterson, ED; Reeves, MJ; Bhatt, DL; Maisch, L; Hannah, D; Lindholm, B ...
Published in: Stroke
October 2016

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.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2016

Volume

47

Issue

10

Start / End Page

2627 / 2633

Location

United States

Related Subject Headings

  • Stroke
  • Registries
  • Quality of Health Care
  • Patient Preference
  • Patient Outcome Assessment
  • Patient Discharge
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
O’Brien, E. C., Xian, Y., Xu, H., Wu, J., Saver, J. L., Smith, E. E., … 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
O’Brien, Emily C., Ying Xian, Haolin Xu, Jingjing Wu, Jeffrey L. Saver, Eric E. Smith, Lee H. Schwamm, et al. “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, no. 10 (October 2016): 2627–33. https://doi.org/10.1161/STROKEAHA.116.013563.
O’Brien, Emily C., et al. “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, vol. 47, no. 10, Oct. 2016, pp. 2627–33. Pubmed, doi:10.1161/STROKEAHA.116.013563.
O’Brien EC, Xian Y, Xu H, Wu J, Saver JL, Smith EE, Schwamm LH, Peterson ED, Reeves MJ, Bhatt DL, Maisch L, Hannah D, Lindholm B, Olson D, Prvu Bettger J, Pencina M, Hernandez AF, Fonarow GC. 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. 2016 Oct;47(10):2627–2633.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2016

Volume

47

Issue

10

Start / End Page

2627 / 2633

Location

United States

Related Subject Headings

  • Stroke
  • Registries
  • Quality of Health Care
  • Patient Preference
  • Patient Outcome Assessment
  • Patient Discharge
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans