Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke.
Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke.
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DOI：
10.1371/journal.pone.0289790
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发表时间：
2023
期刊：
影响因子：
3.7
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中科院分区：
文献类型：
--
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在具有更好的短期结果指标的医院治疗的中风患者是否具有更好的长期结果尚不清楚。我们调查了在美国医院接受治疗时，30天医院级卒中结局指标更好是否与缺血性卒中后患者的1年结局更好相关，包括死亡率降低和卒中复发。这项队列研究纳入了2015年7月1日至2018年12月31日期间从美国医院出院的年龄≥65岁、主要诊断为缺血性卒中的医疗保险按服务付费受益人。我们根据2012年7月1日至2015年6月30日CMS医院特异性30天风险标准化全因死亡率和缺血性卒中再入院指标的治疗医院表现对患者进行分类：低低（CMS死亡率和医院再入院率均<全国比率的第25百分位），（均>第75百分位数）和中等（所有其他医院）。我们使用基于患者人口统计学和临床因素的稳定逆概率权重（IPW）来平衡医院绩效类别之间的特征。我们拟合了考克斯模型，评估了各医院绩效类别中1年全因死亡率和缺血性卒中复发的患者风险，通过IPW加权并考虑竞争风险。共有595，929例卒中患者（平均年龄78.9±8.8岁，54.4%为女性）从2，563家医院（134家低-低，2288家中等，141家高-高）出院。对于低-低、中和高-高医院，1年死亡率分别为23.8%（95%置信区间[CI] 23.3%-24.3%），25.2%复发率分别为8.0%（7.6%~ 8.3%）、7.9%（7.8%~ 8.0%）和8.0%（7.7%~ 8.3%）。与在高-高医院治疗的患者相比，在低-低和中等医院治疗的患者1年死亡率分别降低15%（风险比0.85; 95%CI 0.82-0.87）和9%（0.91; 0.89-0.93），但复发率无差异。与在其他医院接受治疗的患者相比，在CMS短期结局指标更好的医院接受治疗的缺血性卒中患者出院后1年死亡率风险较低，但复发卒中率相似。
Whether stroke patients treated at hospitals with better short-term outcome metrics have better long-term outcomes is unknown. We investigated whether treatment at US hospitals with better 30-day hospital-level stroke outcome metrics was associated with better 1-year outcomes, including reduced mortality and recurrent stroke, for patients after ischemic stroke. This cohort study included Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital’s performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission measures for ischemic stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were <25th percentile of national rates), High-High (both >75th percentile), and Intermediate (all other hospitals). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models assessing patient risks of 1-year all-cause mortality and ischemic stroke recurrence across hospital performance categories, weighted by the IPW and accounting for competing risks. There were 595,929 stroke patients (mean age 78.9±8.8 years, 54.4% women) discharged from 2,563 hospitals (134 Low-Low, 2288 Intermediate, 141 High-High). For Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% confidence interval [CI] 23.3%-24.3%), 25.2% (25.1%-25.3%), and 26.5% (26.1%-26.9%), and recurrence rates were 8.0% (7.6%-8.3%), 7.9% (7.8%-8.0%), and 8.0% (7.7%-8.3%). Compared with patients treated at High-High hospitals, those treated at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82–0.87) and 9% (0.91; 0.89–0.93) lower risks of 1-year mortality but no difference in recurrence. Ischemic stroke patients treated at hospitals with better CMS short-term outcome metrics had lower risks of post-discharge 1-year mortality, but similar recurrent stroke rates, compared with patients treated at other hospitals.
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影响因子：
15.8
作者：
通讯作者：
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DOI：
10.1016/j.jstrokecerebrovasdis.2018.10.022
发表时间：
2019-02-01
影响因子：
2.5
作者：
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影响因子：
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作者：
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影响因子：
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作者：
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通讯作者：
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