TY - JOUR
T1 - Hospital Variation in Home-Time after Acute Ischemic Stroke
T2 - Insights from the PROSPER Study (Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research)
AU - O'Brien, Emily C.
AU - Xian, Ying
AU - Xu, Haolin
AU - Wu, Jingjing
AU - Saver, Jeffrey L.
AU - Smith, Eric E.
AU - Schwamm, Lee H.
AU - Peterson, Eric D.
AU - Reeves, Mathew J.
AU - Bhatt, Deepak L.
AU - Maisch, Lesley
AU - Hannah, Deidre
AU - Lindholm, Brianna
AU - Olson, Daiwai
AU - Prvu Bettger, Janet
AU - Pencina, Michael
AU - Hernandez, Adrian F.
AU - Fonarow, Gregg C.
N1 - Funding Information:
Sources of Funding The Get With The Guidelines-Stroke (GWTG-Stroke) program is provided by the American Heart Association (AHA)/American Stroke Association. GWTG-Stroke is sponsored, in part, by Medtronic and has been funded in the past through support from Boehringer- Ingelheim, Merck, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, Janssen Pharmaceutical Companies of Johnson & Johnson, and the AHA Pharmaceutical Roundtable. Duke Clinical Research Institute (DCRI) served as the data analysis center. This project was powered by Quintiles, Cambridge, MA. PROSPER study was supported by an award (CE-1304-7073) from the Patient- Centered Outcomes Research Institute (PCORI).
Funding Information:
Dr Fonarow reports serving as a member of the Get With The Guidelines (GWTG) steering committee; receiving significant research support from the National Institutes of Health (NIH) and Patient-Centered Outcomes Research Institute (PCORI); and being an employee of the University of California, which holds a patent on retriever devices for stroke. Dr Schwamm reports being the principal investigator of an investigator-initiated study of extended-window intravenous thrombolysis funded by the National Institute of Neurological Disorders and Stroke (NINDS; clinicaltrials.gov/ show/NCT01282242) for which Genentech provides alteplase free of charge to Massachusetts General Hospital and supplemental per-patient payments to participating sites; serving as a chair of the AHA/ASA GWTG–stroke clinical work group; serving as a stroke systems’ consultant to the Massachusetts Department of Public Health; and serving as a scientific consultant regarding trial design and conduct to Lundbeck (international steering committee, DIAS3, 4 trial) and Penumbra (data and safety monitoring committee, Separator 3D trial). Dr Bhatt discloses being in the advisory board of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; serving in the board of directors at Boston VA Research Institute, Society of Cardiovascular Patient Care; serving as a chair in the American Heart Association (AHA) Quality Oversight Committee; being in data monitoring committees such as Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; receiving honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (Clinical Trial Steering Committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (secretary/ treasurer), WebMD (CME Steering Committees); his other disclosures are as follows: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Vice-Chair), VA CART Research and Publications Committee (Chair); he received research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, and The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical; Trustee: American College of Cardiology; Unfunded Research: FlowCo, PLx Pharma, Takeda. Dr Smith reports serving as a member of the GWTG steering committee. Dr Peterson reports receiving research grants from Lilly, Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and Merck-Schering Plough partnership; and serving as principal investigator of the data analytic center for the AHA/American Stroke Association’s (ASA) GWTG. Dr Hernandez reports receiving a research grant from Amgen, Astra Zeneca, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Merck, Novartis, and Portola Pharmaceuticals and receiving honoraria from Amgen, Bristol Myers Squibb, Merck, and Novartis. The other authors report no conflicts.
Funding Information:
The Get With The Guidelines–Stroke (GWTG-Stroke) program is provided by the American Heart Association (AHA)/American Stroke Association. GWTG-Stroke is sponsored, in part, by Medtronic and has been funded in the past through support from Boehringer-Ingelheim, Merck, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership, Janssen Pharmaceutical Companies of Johnson & Johnson, and the AHA Pharmaceutical Roundtable. Duke Clinical Research Institute (DCRI) served as the data analysis center. This project was powered by Quintiles, Cambridge, MA. PROSPER study was supported by an award (CE-1304–7073) from the Patient-Centered Outcomes Research Institute (PCORI).
Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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.
AB - 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.
KW - health services research
KW - healthcare quality assessment
KW - patient centered outcomes research
KW - risk adjustment
KW - stroke, acute
UR - http://www.scopus.com/inward/record.url?scp=84987600792&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84987600792&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.116.013563
DO - 10.1161/STROKEAHA.116.013563
M3 - Article
C2 - 27625383
AN - SCOPUS:84987600792
SN - 0039-2499
VL - 47
SP - 2627
EP - 2633
JO - Stroke
JF - Stroke
IS - 10
ER -