Hospital Variation in Home-Time After Acute Ischemic Stroke Insights From the PROSPER Study (Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research)
Hospital Variation in Home-Time After Acute Ischemic Stroke Insights From the PROSPER Study (Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research)
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DOI：
10.1161/strokeaha.116.013563
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发表时间：
2016-10-01
期刊：
影响因子：
8.3
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
O'Brien, Emily C.;Xian, Ying;Fonarow, Gregg C.
背景和目的 中风幸存者将家庭时间视为高度优先的结果；关于影响出院医院家庭时间和家庭时间变异性的因素的数据有限。 方法 - 我们通过将来自《指南》中风登记处患者（> = 65 岁）的数据与医疗保险索赔联系起来，确定了出院后 90 天和 1 年的家庭时间（即离开医院、住院康复机构或专业护理机构的存活时间）。使用广义线性混合模型，我们估计了每家医院调整后的平均在家时间。使用线性回归，我们检查了医院特征和风险调整后的居家时间之间的关联。结果 - 我们将 989 家医院的 156887 名缺血性中风患者与医疗保险索赔（2007-2011 年）联系起来。医院平均在家时间各不相同，前 90 天的总体未调整中位数为 59.5 天，第一年为 270.2 天。与超过 90 天的居家时间相关的医院因素包括较高的年中风入院量（每年缺血性中风入院人数）；南部、西部或中西部地理区域（相对于东北部）；和乡村位置； 1 年模式相似。家庭时间最低四分位数的患者（与最高四分位患者相比）更有可能是老年人、黑人、女性，并且有更多的合并症和严重中风。风险调整后，居住时间变异减少（四分位距，90 天期间为 57.4-61.4 天；1 年期间为 266.3-274.2 天）。在调整后的分析中，年中风量的增加和农村地区与显着增加的家庭时间相关。结论：在老年缺血性中风幸存者中，出院后的家庭时间因医院年中风量、病例组合的严重程度和地区而异。在调整后的分析中，每年缺血性卒中入院人数和农村地区与卒中后更多的居家时间相关。
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 156887 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.