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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.

Duke Scholars

Dimensions Citation Stats

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

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