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Hospital Variation in Functional Recovery After Stroke.

Publication ,  Journal Article
Bettger, JP; Thomas, L; Liang, L; Xian, Y; Bushnell, CD; Saver, JL; Fonarow, GC; Peterson, ED
Published in: Circ Cardiovasc Qual Outcomes
January 2017

BACKGROUND: Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. METHODS AND RESULTS: Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. CONCLUSIONS: One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

January 2017

Volume

10

Issue

1

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke Rehabilitation
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Recovery of Function
  • Quality Indicators, Health Care
  • Prospective Studies
 

Citation

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Bettger, J. P., Thomas, L., Liang, L., Xian, Y., Bushnell, C. D., Saver, J. L., … Peterson, E. D. (2017). Hospital Variation in Functional Recovery After Stroke. Circ Cardiovasc Qual Outcomes, 10(1). https://doi.org/10.1161/CIRCOUTCOMES.115.002391
Bettger, Janet Prvu, Laine Thomas, Li Liang, Ying Xian, Cheryl D. Bushnell, Jeffrey L. Saver, Gregg C. Fonarow, and Eric D. Peterson. “Hospital Variation in Functional Recovery After Stroke.Circ Cardiovasc Qual Outcomes 10, no. 1 (January 2017). https://doi.org/10.1161/CIRCOUTCOMES.115.002391.
Bettger JP, Thomas L, Liang L, Xian Y, Bushnell CD, Saver JL, et al. Hospital Variation in Functional Recovery After Stroke. Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1).
Bettger, Janet Prvu, et al. “Hospital Variation in Functional Recovery After Stroke.Circ Cardiovasc Qual Outcomes, vol. 10, no. 1, Jan. 2017. Pubmed, doi:10.1161/CIRCOUTCOMES.115.002391.
Bettger JP, Thomas L, Liang L, Xian Y, Bushnell CD, Saver JL, Fonarow GC, Peterson ED. Hospital Variation in Functional Recovery After Stroke. Circ Cardiovasc Qual Outcomes. 2017 Jan;10(1).

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

January 2017

Volume

10

Issue

1

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke Rehabilitation
  • Stroke
  • Risk Factors
  • Risk Assessment
  • Recovery of Function
  • Quality Indicators, Health Care
  • Prospective Studies