Predicting REadmission after Stroke Study (PRESS)

项目总结 中风对患者、他们的照顾者和卫生系统都有巨大的影响。大约795,000人 美国每个国家都会发生中风病例。它是第五大致死原因和长期致死的首要原因。 美国有近700万中风幸存者。每年中风的总成本预计为 到2030年增加2410亿美元，是2012年成本(1050亿美元)的两倍多。鉴于沙尘暴的破坏性影响 中风，更可悲的是，相当大比例的中风幸存者将被重新送入 医院：目前30天的全原因再住院率从6.5-24.3%不等，这些比率上升到30.0- 一年内62.2%。此外，初次住院后的死亡率也很高，5%-7%的病例 病死率，30天时为13-15%，1年时为25-30%。 尽管中风很重要，但关于哪些患者和医院--的量化数据非常少 水平因素在卒中患者再入院和出院后死亡率中起决定性作用。为 例如，对中风后再次住院的预测因素进行的系统回顾没有得出风险标准化的结果 比较中风后再入院表现或预测再入院风险的模型。 我们建议加强对中风患者的护理，并为临床、基础科学和 卫生政策研究人员通过仔细分析中风结局和患者之间的关系 医院级别的预测者。我们的长期目标是开发全面的风险分层工具， 告知随机试验的设计、个别患者的护理标准和公共报告。晋级 这一目标，我们有以下具体目标。 1.我们将确定患者和医院级别的再入院和出院后预测因素的特征 21家医院卒中患者死亡率调查 2.我们将开发并前瞻性地验证30天再入院和死亡率的预测模型 中风住院治疗后

PROJECT SUMMARY Stroke has a massive impact on patients, their caregivers, and the health system. Approximately 795,000 stroke cases occur each in the US. It is the fifth leading cause of death and the leading cause of long-term disability, with nearly 7 million stroke survivors in the US. The total annual costs of stroke are projected to increase $241 billion by 2030, more than twice the cost in 2012 ($105 billion). Given the devastating effects of a stroke, it is all the more tragic that a substantial proportion of stroke survivors will be readmitted to the hospital: current 30-day all-cause readmission rates range from 6.5-24.3% and these rates increase to 30.0- 62.2% within one year. Moreover, mortality following the initial hospitalization is also substantial, 5-7% case fatality, 13-15% at 30 days, and 25-30% at 1 year. Despite stroke’s importance, remarkably little quantitative data are available on what patient- and hospital- level factors play a determinant role in readmission and post-discharge mortality in stroke patients. For example, a systematic review of predictors of hospital readmission after stroke yielded no risk-standardized models for comparing hospital readmission performance or predicting readmission risk after stroke. We propose to enhance the care of stroke patients and to provide guidance for clinical, basic science, and health policy researchers by a careful analysis of the relationship between stroke outcomes and patient- and hospital-level predictors. Our long term goal is to develop comprehensive risk stratification tools that could inform the design of randomized trials, individual patient standards of care, and public reporting. To advance this goal, we have the following Specific Aims. 1. We will characterize patient- and hospital-level predictors for readmission and post-discharge mortality among stroke patients from 21 hospitals 2. We will develop and prospectively validate predictive models for 30-day readmission and mortality following hospitalization for stroke