Stroke Hospitalization in the Elderly with Medicare FFS

老年人中风住院医疗保险 FFS

• 批准号: 7841207
• 负责人: JUDITH H LICHTMAN
• 金额: $ 96.1万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-02-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7841207
• 关键词: Admission activity; Adult; Age; Aged, 80 and over; American; American Heart Association; Blood Vessels; Cardiovascular Diseases; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic Disease; Clinical; Clinical Research; Cohort Studies; Communities; Congresses; Contracts; Coronary heart disease; Country; Data; Data Set; Databases; Demographic Factors; Diabetes Mellitus; Diagnosis; Disease; Disease Outcome; District of Columbia; Economics; Elderly; Ethnic Origin; Evaluation; Event; Family health status; Fee-for-Service Plans; Frequencies; Gender; Geographic Locations; Geography; Goals; Grant; Health Promotion; Healthcare; Healthcare Systems; Healthy People 2000; Healthy People 2010; Heart; Heart Diseases; Heterogeneity; High Prevalence; Hospital Mortality; Hospitalization; Hospitals; Hour; Incidence; Individual; Inpatients; Institution; International; Investigation; Ischemic Stroke; Knowledge; Life; Link; Long Term Survivorship; Measures; Medicare; Medicare Part A; Methodology; Minority; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Occupations; Outcome; Outpatients; Parents; Patients; Pattern; Patterns of Care; Physicians; Population; Prevalence; Prevention; Principal Investigator; Public Health; Public Policy; Race; Recurrence; Rehabilitation therapy; Research; Research Personnel; Research Priority; Research Support; Resources; Rural; Sampling; Services; Source; Stratification; Stroke; Stroke prevention; Structure; Subgroup; System; Time; Training; United States; United States Dept. of Health and Human Services; United States National Institutes of Health; Variant; Vascular Diseases; Visit; Woman; Work; age group; base; beneficiary; cardiovascular disorder prevention; clinical practice; cohort; computing resources; cost; demographics; disability; disorder prevention; follow-up; health care service utilization; improved; insight; meetings; mortality; national surveillance; older patient; prevent; public health relevance; racial and ethnic; racial difference; sex; socioeconomics; surveillance data; symposium; trend

DESCRIPTION (provided by principal investigator): This country lacks a cohesive, informative surveillance system for vascular disease that can provide insights into national patterns of stroke and reveal national trends over time. Stroke is a major public health problem in the United States. It is the third leading cause of death and a leading cause of serious disability in adults. Its high prevalence and associated deficits impose a large burden on patients, their families, and the health care system. This is especially true among the elderly for whom stroke is a leading cause for hospitalization. Of patients hospitalized with stroke, two-thirds are over age 65; half are over age 70 years. We have assembled an unprecedented national resource by creating a longitudinal Medicare database for fee-for-service (FFS) patients hospitalized with vascular diagnoses over the years 1992-2003, with ability to link additional years of follow-up to the database. Previous studies using Medicare databases have generally employed a cross-sectional approach, not linking, at the patient level, the entire Medicare Part A (hospital admissions) database over time. No other organization or institution has developed such a national database. Our objective is to provide the most comprehensive evaluation of stroke and its outcomes among hospitalized Medicare FFS beneficiaries in the United States. This Competitive Revision Application expands the scope of our current research on stroke surveillance by focusing on incident stroke rates, trends, and outcomes in the elderly, for which we have very little national data. The project leverages the resources, structure, and methodologies established in the current SHEF Study (Parent R01) in which we have examined rates, trends, and outcomes for prevalent ischemic stroke. We recently purchased inpatient data and denominator data for 2004-2006, as well as outpatient and carrier file (physician visit data) for 2005-2006. We plan to link the new data with the existing database. This will provide a 15-year, patient linked data resource that spans from 1992-2006. We will conduct preliminary analyses to describe the utilization of resources (in-hospital, outpatient, and physician services) within the first year following hospital discharge of ischemic stroke. Information on the full burden and cost of stroke is very limited in this population, particularly in terms of how utilization patterns compare for incident or recurrent events, or by the presence of concomitant conditions such as diabetes. Additional resources for this study will accelerate the tempo of this scientific research, allow for job creation of recently trained professionals, provide job retention for current staff, and provide clinical expertise to support this research on national stroke incidence and outcomes in the elderly. Results from the study will provide clinicians, investigators, and policymakers with the best estimates to date of the current burden and national patterns of stroke incidence among the elderly, especially among different subgroups of our population. These results will help inform decisions about the allocation of adequate resources, and more importantly, help identify opportunities to improve care and prevention of elderly stroke patients. PUBLIC HEALTH RELEVANCE: Results from the study will provide clinicians, investigators, and policymakers with the best estimates to date of the current national burden of stroke hospitalizations and outcomes among the elderly, especially among different subgroups of our population. These results will help inform decisions about the allocation of adequate resources, and more importantly, help identify opportunities to improve care and prevention of elderly stroke patients.

描述（由首席研究员提供）：这个国家缺乏一个有凝聚力的、信息丰富的血管疾病监测系统，该系统可以提供对全国中风模式的见解，并揭示全国随时间的趋势。中风是美国一个主要的公共卫生问题。它是导致死亡的第三大原因，也是导致成年人严重残疾的主要原因。它的高流行率和相关的缺陷给病人、他们的家庭和卫生保健系统带来了巨大的负担。在老年人中尤其如此，因为中风是住院治疗的主要原因。在因中风住院的患者中，三分之二的人年龄超过65岁；其中一半超过70岁。我们通过建立按服务收费（FFS）的纵向医疗保险数据库，汇集了前所未有的国家资源

项目成果

Stroke patient outcomes in US hospitals before the start of the Joint Commission Primary Stroke Center certification program.

• DOI: 10.1161/strokeaha.109.561472
• 发表时间: 2009-11
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Lichtman JH;Allen NB;Wang Y;Watanabe E;Jones SB;Goldstein LB
• 通讯作者: Goldstein LB

Elderly women have lower rates of stroke, cardiovascular events, and mortality after hospitalization for transient ischemic attack.

• DOI: 10.1161/strokeaha.108.543009
• 发表时间: 2009-06
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Lichtman JH;Jones SB;Watanabe E;Allen NB;Wang Y;Howard VJ;Goldstein LB
• 通讯作者: Goldstein LB

Postendarterectomy mortality in octogenarians and nonagenarians in the USA from 1993 to 1999.

1993 年至 1999 年美国八旬老人和九十岁老人动脉内膜切除术后死亡率。

• DOI: 10.1159/000262312
• 发表时间: 2010
• 期刊: Cerebrovascular diseases (Basel, Switzerland)
• 作者: Lichtman,JudithH;Jones,SaraB;Wang,Yun;Watanabe,Emi;Allen,NorrinaB;Fayad,Pierre;Goldstein,LarryB
• 通讯作者: Goldstein,LarryB

Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries.

• DOI: 10.1161/strokeaha.113.003165
• 发表时间: 2013-12
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Lichtman JH;Leifheit-Limson EC;Jones SB;Wang Y;Goldstein LB
• 通讯作者: Goldstein LB