Representativeness of the Get With The Guidelines-Stroke Registry Comparison of Patient and Hospital Characteristics Among Medicare Beneficiaries Hospitalized With Ischemic Stroke
Representativeness of the Get With The Guidelines-Stroke Registry Comparison of Patient and Hospital Characteristics Among Medicare Beneficiaries Hospitalized With Ischemic Stroke
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DOI：
10.1161/strokeaha.111.626978
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发表时间：
2012-01-01
期刊：
影响因子：
8.3
通讯作者：
Schwamm, Lee H.
中科院分区：
文献类型：
--
作者：
Reeves, Mathew J.;Fonarow, Gregg C.;Schwamm, Lee H.
背景和目的-遵循指南（GWTG）-卒中是一项基于质量改善的大型急性卒中登记研究;然而，其普遍性尚不清楚。我们使用按服务收费的医疗保险索赔来确定GWTG-Stroke中缺血性卒中入院的代表性。方法-在2003年4月至2007年12月期间，GWTG-Stroke中登记的所有228815例年龄>= 65岁的缺血性卒中入院与926756例独特的按服务收费的医疗保险缺血性卒中患者相关（主要国际疾病分类，第9次修订出院代码434或436）。比较关联GWTG-卒中医疗保险队列和其余未关联医疗保险队列的患者特征和住院结局。将GWTG-中风医院的特征与非GWTG-中风医院进行比较。结果-228，815例GWTG-中风入院患者中，共有144，344例（63.1%）成功与926，756名医疗保险缺血性中风受益人联系起来，剩下782，412名未联系的医疗保险患者。患者特征的差异，包括年龄，种族，性别和合并症，之间的联系和非联系的医疗保险队列是最小的。关联组和非关联组的住院时间和出院率几乎相同;然而，关联医疗保险队列的住院死亡率（6.3%）略低于非关联队列（7.0%）。GWTG中风和非GWTG中风医院之间的医院特征有很大的差异; GWTG中风医院往往是更大的，城市，teachingcenters. Conclusions，尽管GWTG中风和非GWTG中风医院之间有很大的差异，进入GWTG中风计划的急性缺血性中风的医疗保险受益人与其他医疗保险受益人相似。这些数据表明，Medicare老年GWTG-卒中缺血性卒中入院通常代表了全国按服务付费的Medicare缺血性卒中人群。（中风。2012;43：44-49.）
Background and Purpose-Get With The Guidelines (GWTG)-Stroke is a large quality improvement-based registry of acute stroke; however, its generalizability is unclear. We used fee-for-service Medicare claims to ascertain the representativeness of ischemic stroke admissions in GWTG-Stroke.Methods-All 228 815 ischemic stroke admissions aged >= 65 years enrolled in GWTG-Stroke between April 2003 and December 2007 were linked to 926 756 unique fee-for-service Medicare patients with ischemic stroke (primary International Classification of Diseases, 9th Revision discharge code 434 or 436) from the same period. Patient characteristics and in-hospital outcomes were compared between the linked GWTG-Stroke Medicare cohort and the remaining unlinked Medicare cohort. Characteristics of GWTG-Stroke hospitals were compared with non-GWTG-Stroke hospitals.Results-A total of 144 344 of the 228,815 GWTG-Stroke admissions (63.1%) were successfully linked to the 926 756 Medicare ischemic stroke beneficiaries, leaving 782 412 unlinked Medicare patients. Differences in patient characteristics, including age, race, gender, and comorbidities, between the linked and unlinked Medicare cohorts were minimal. Length of stay and rate of discharge home were almost identical between the linked and unlinked groups; however, in-hospital mortality was slightly lower in the linked Medicare cohort (6.3%) compared with the unlinked cohort (7.0%). There were large differences in hospital characteristics between GWTG-Stroke and non-GWTG-Stroke hospitals; GWTG-Stroke hospitals tended to be larger, urban, teaching centers.Conclusions-Despite substantial differences between GWTG-Stroke and non-GWTG-Stroke hospitals, Medicare beneficiaries with acute ischemic stroke entered in the GWTG-Stroke program were similar to other Medicare beneficiaries. These data suggest that the Medicare-aged GWTG-Stroke ischemic stroke admissions are generally representative of the national fee-for-service Medicare ischemic stroke population. (Stroke. 2012;43:44-49.)