Emily C O'Brien1, Ying Xian2, Haolin Xu2, Jingjing Wu2, Jeffrey L Saver2, Eric E Smith2, Lee H Schwamm2, Eric D Peterson2, Mathew J Reeves2, Deepak L Bhatt2, Lesley Maisch2, Deidre Hannah2, Brianna Lindholm2, DaiWai Olson2, Janet Prvu Bettger2, Michael Pencina2, Adrian F Hernandez2, Gregg C Fonarow2. 1. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., Y.X., H.X., J.W., E.D.P., J.P.B., M.P., A.F.H.); University of California at Los Angeles (J.L.S., G.C.F.); Hotchkiss Brain Institute, University of Calgary, Canada (E.E.S.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and University of Texas Southwestern, Dallas (D.O.). emily.obrien@duke.edu. 2. From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., Y.X., H.X., J.W., E.D.P., J.P.B., M.P., A.F.H.); University of California at Los Angeles (J.L.S., G.C.F.); Hotchkiss Brain Institute, University of Calgary, Canada (E.E.S.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); and University of Texas Southwestern, Dallas (D.O.).
Abstract
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.
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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