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30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals.

Publication ,  Journal Article
Lichtman, JH; Leifheit-Limson, EC; Jones, SB; Wang, Y; Goldstein, LB
Published in: Stroke
October 2012

BACKGROUND AND PURPOSE: The critical access hospital (CAH) designation was established to provide rural residents with local access to emergency and inpatient care. CAHs, however, have poorer short-term outcomes for pneumonia, heart failure, and myocardial infarction compared with other hospitals. We assessed whether 30-day risk-standardized mortality rates (RSMRs) and risk-standardized readmission rates (RSRRs) after ischemic stroke differ between CAHs and non-CAHs. METHODS: The study included all fee-for-service Medicare beneficiaries 65 years of age or older with a primary discharge diagnosis of ischemic stroke (International Classification of Diseases, 9th revision codes 433, 434, 436) in 2006. Hierarchical generalized linear models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, medical history, and comorbid conditions. Non-CAHs were categorized by hospital volume quartiles and the RSMR and RSRR posterior probabilities in comparison with CAHs were determined using linear regression with Markov chain Monte Carlo simulation. RESULTS: There were 10 267 ischemic stroke discharges from 1165 CAHs and 300 114 discharges from 3381 non-CAHs. The RSMRs of CAHs were higher than non-CAHs (11.9%± 1.4% vs 10.9%± 1.7%; P<0.001), but the RSRRs were comparable (13.7%± 0.6% vs 13.7%± 1.4%; P=0.3). The RSMRs for the 2 higher volume quartiles of non-CAHs were lower than CAHs (posterior probability of RSMRs higher than CAHs=0.007 for quartile 3; P<0.001 for quartile 4), but there were no differences for lower volume hospitals; RSRRs did not vary by annual hospital volume. CONCLUSIONS: CAHs had higher RSMRs compared with non-CAHs, but readmission rates were similar. The observed differences may be partly explained by patient characteristics and annual hospital volume.

Duke Scholars

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2012

Volume

43

Issue

10

Start / End Page

2741 / 2747

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Stroke
  • Rural Health Services
  • Risk Factors
  • Retrospective Studies
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Medicare
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lichtman, J. H., Leifheit-Limson, E. C., Jones, S. B., Wang, Y., & Goldstein, L. B. (2012). 30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals. Stroke, 43(10), 2741–2747. https://doi.org/10.1161/STROKEAHA.112.665646
Lichtman, Judith H., Erica C. Leifheit-Limson, Sara B. Jones, Yun Wang, and Larry B. Goldstein. “30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals.Stroke 43, no. 10 (October 2012): 2741–47. https://doi.org/10.1161/STROKEAHA.112.665646.
Lichtman JH, Leifheit-Limson EC, Jones SB, Wang Y, Goldstein LB. 30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals. Stroke. 2012 Oct;43(10):2741–7.
Lichtman, Judith H., et al. “30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals.Stroke, vol. 43, no. 10, Oct. 2012, pp. 2741–47. Pubmed, doi:10.1161/STROKEAHA.112.665646.
Lichtman JH, Leifheit-Limson EC, Jones SB, Wang Y, Goldstein LB. 30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals. Stroke. 2012 Oct;43(10):2741–2747.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

October 2012

Volume

43

Issue

10

Start / End Page

2741 / 2747

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Stroke
  • Rural Health Services
  • Risk Factors
  • Retrospective Studies
  • Patient Readmission
  • Outcome Assessment, Health Care
  • Neurology & Neurosurgery
  • Medicare