Stroke Hospitalization in the Elderly with Medicare FFS

描述（由申请人提供）：该国缺乏一个有凝聚力的、信息丰富的血管疾病监测系统，该系统可以提供对国家脑血管疾病模式的见解，并揭示国家长期趋势。我们的总体目标是为在美国住院的大多数中风患者建立一个监测系统，这些患者年龄在50 - 65岁之间，他们参加了医疗保险按服务收费（FFS）方案。我们为1992-1999年间因血管诊断住院的患者创建了纵向医疗保险数据库，并能够添加年份（到2003年作为该项目的一部分），从而收集了前所未有的国家资源。自我们最初提交以来，我们的团队克服了相当大的技术困难来创建这个数据库。这项工作需要将5,000多个数据磁带转换为包含超过1tb数据的可行数据资源。先前使用医疗保险数据库的研究采用了横断面方法，而不是在患者水平上连接整个医疗保险a部分（住院）数据库。没有其他组织或机构，甚至没有医疗保险和医疗补助服务中心（CMS）开发过这样的数据库。我们的目标是对美国住院医疗保险FFS受益人的中风和短期死亡率结果进行最全面的评估。评估将涵盖整个美国，跨度超过十年。据此，我们提出以下具体目标：目的：确定美国医疗保险受益人中风住院率。确定美国医疗保险受益人中风住院后的住院率和30天死亡率。确定年龄、种族和民族、经济、政治和地理特征等亚组中风住院模式。4. 我们的工作将有助于更好地界定老年人脑卒中负担，为决策者和临床医生规划脑卒中患者的卫生保健需求提供信息，并帮助确定干预目标，以加强对脑卒中患者的护理。

DESCRIPTION (provided by applicant): This country lacks a cohesive, informative surveillance system for vascular disease that can provide insights into national patterns of cerebrovascular disease and reveal national trends over time. Our overall goal is to build a surveillance system for the majority of patients admitted to the hospital with stroke in the United States, patients age > 65 years who are enrolled in the Medicare fee-for-service (FFS) option. We have assembled an unprecedented national resource by creating a longitudinal Medicare database for patients hospitalized with vascular diagnoses over the years 1992-1999, with ability to add years (through 2003 as part of this project). Since our original submission, our team has overcome considerable technical difficulties to create this database. This work has entailed transforming more than 5,000 data tapes into a viable data resource containing more than a terabyte of data. Previous studies using Medicare databases have 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, not even the Centers for Medicare & Medicaid Services (CMS), has developed such a database. Our objective is to provide the most comprehensive evaluation of stroke and short-term mortality outcomes among hospitalized Medicare FFS beneficiaries in the United States. The evaluation will encompass the entire United States and span more than a decade. Accordingly, we propose the following specific aims: 1. To determine rates of stroke hospitalizations among Medicare beneficiaries in the United States. 2. To determine rates of hospital and 30-day mortality following stroke hospitalization among Medicare beneficiaries in the United States. 3. To determine patterns of stroke hospitalization among subgroups including by age, race and ethnicity, and by economic, political, and geographic characteristics. 4. To measure trends in stroke hospitalization rates over time Our work will help better define the burden of stroke among the elderly, inform policy-makers and clinicians in planning for the health care needs of stroke patients, and help identify targets for interventions to enhance the care of patients with stroke.