Stroke Hospitalization in the Elderly with Medicare FFS

描述(由申请者提供)：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，无法提供对全国脑血管疾病模式的洞察，并揭示随着时间的推移的国家趋势。我们的总体目标是为美国住院的大多数中风患者建立一个监测系统，这些患者年龄和65岁都参加了联邦医疗保险按服务收费(FFS)选项。我们通过为1992-1999年间因血管诊断住院的患者创建了一个纵向的医疗保险数据库，并能够增加年限(作为该项目的一部分，到2003年)，从而汇集了前所未有的全国资源。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5000多盘数据磁带转变为包含1TB以上数据的可行数据资源。以前使用联邦医疗保险数据库的研究采用了横断面方法，而不是在患者层面上随着时间的推移将整个联邦医疗保险A部分(住院)数据库联系起来。没有其他组织或机构，甚至包括医疗保险和医疗补助服务中心(CMS)，都没有开发过这样的数据库。我们的目标是对美国住院的联邦医疗保险FFS受益者的中风和短期死亡率结果进行最全面的评估。这项评估将涵盖整个美国，时间跨度超过十年。因此，我们提出了以下具体目标：1.确定美国医疗保险受益人的中风住院率。2.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。3.根据年龄、种族和民族，以及经济、政治和地理特征，确定不同亚组的中风住院模式。4.为了衡量中风住院率随时间的变化趋势，我们的工作将有助于更好地确定老年人中风的负担，为政策制定者和临床医生规划中风患者的医疗需求提供信息，并帮助确定干预措施的目标，以加强对中风患者的护理。

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.