Impact of Aging on Stroke Care: A National Perspective

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DESCRIPTION (provided by investigator): Our goal is to examine the impact of aging on stroke care in the United States. Our application proposes secondary analysis of data collected as part of the National Stroke Project. The National Stroke Project was part of a Center for Medicare and Medicaid Study (CMS) program (formerly know as the Health Care Financing Administration (HCFA)) to look at quality indicators for stroke care by state. The specific aims and proposed analyses of this R03 application go beyond the analyses proposed, and funding available for, the National Stroke Project. Our application is ideally suited to PA Number: PA-01-082 (Data analysis and Archiving in Demography, Economics, and Behavioral Research on Aging). The R03 Award will permit an analysis of the National Stroke Project database related to measuring and understanding the age-related disparities in stroke care across the United States. Our analyses will yield the first national picture of how age influences the care of elderly patients admitted to the hospital with stroke. In addition, the results of this RO3 will provide new analyses critical to informing the design and content of a planned RO1 linking processes of inpatient care from the elderly patients included in the National Stroke Project with long-term outcomes. The objective of this proposal is to provide insight into how aging influences stroke care both directly and through its association with other factors including demographics, clinical co-morbidities, hospital and physician characteristics, and geography. These results will be critical to enhancing clinical decision-making and performance benchmarking. Accordingly we have set specific aims: 1-to determine the influence of age on the management of acute ischemic stroke; 2-to determine if the impact of age on stroke care is different within the 'Stroke Belt'; and 3-to examine whether hospital and physician characteristics contribute to age related differences in stroke care. Some studies have raised questions about how demographic and clinical factors contribute to the variations seen in the care and outcomes of patients with cerebro-vascular disease, but few data are available regarding how these factors specifically affect the use of specific diagnostic techniques and stroke therapies in older patients with stroke. We hypothesize that variations in care exist by age. Moreover, these differences in care will not be explained by differences clinical features or co-morbid conditions associated with aging.