The price of bouncing back: One-year mortality and payments for acute stroke patients with 30-day bounce-backs
The price of bouncing back: One-year mortality and payments for acute stroke patients with 30-day bounce-backs
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DOI：
10.1111/j.1532-5415.2008.01693.x
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发表时间：
2008-06-01
影响因子：
6.3
通讯作者：
Finch, Michael D.
中科院分区：
文献类型：
--
作者：
Kind, Amy J. H.;Smith, Maureen A.;Finch, Michael D.
目的：研究出院后30天内经历零次、一次、两次或更多次反弹的中风患者的1年死亡率和医疗费用。设计：行政数据的回顾性分析。地点：美国南部和东部的422家医院。参与者：2000年，11729名65岁及以上的医疗保险受益人因急性缺血性卒中存活至少30天。分别采用对数正态生存参数分析和分位数回归计算一年死亡率和预测的总医疗费用。模型包括社会人口统计学，既往病史，中风的严重程度，住院时间，和出院site.Results：粗生存率在1年的零，一个和两个或更多的反弹组分别为83%，67%和55%。与零反弹组相比，一次反弹组的调整后1年生存时间短49%（时间比（TR）=0.51，95%置信区间（CI）=0.46-0.56），两次或多次反弹组的调整后1年生存时间短68%（TR=0.32，95% CI=0.27-0.38）。对于高成本和低成本的患者，调整后的预测付款更大的每一个额外的反弹experienced.CONCLUSION：急性中风患者经历反弹在30天内有显着较差的生存和更高的医疗费用在随后的一年比他们的同行没有反弹。反弹可以作为一个简单的预测识别中风患者在极高的风险，为穷人的结果。
OBJECTIVES: To examine 1-year mortality and healthcare payments of stroke patients experiencing zero, one and two or more bounce-backs within 30 days of discharge.DESIGN: Retrospective analysis of administrative data.SETTING: Four hundred twenty-two hospitals in the southern and eastern United States.PARTICIPANTS: Eleven thousand seven hundred twenty-nine Medicare beneficiaries aged 65 and older surviving at least 30 days with acute ischemic stroke in 2000.MEASUREMENTS: One-year mortality and predicted total healthcare payments were calculated using log-normal parametric survival analysis and quantile regression, respectively. Models included sociodemographics, prior medical history, stroke severity, length of stay, and discharge site.RESULTS: Crude survival at 1 year for the zero, one and two or more bounce-back groups was 83%, 67%, and 55%, respectively. The one bounce-back group had 49% shorter (time ratio (TR)=0.51, 95% confidence interval (CI)=0.46-0.56) and the two or more bounce-backs group had 68% shorter (TR=0.32, 95% CI=0.27-0.38) adjusted 1-year survival time than the zero bounce-back group. For high- and low-cost patients, adjusted predicted payments were greater with each additional bounce-back experienced.CONCLUSION: Acute stroke patients experiencing bounce-backs within 30 days have strikingly poorer survival and higher healthcare payments over the subsequent year than their counterparts with no bounce-backs. Bounce-backs may serve as a simple predictor for identifying stroke patients at extremely high risk for poor outcomes.