Abstract 13608: Center Variation in Home Time Following Acute Ischemic Stroke
Background: Stroke survivors have identified that home time is a high priority outcome, but there are limited data on factors associated with time at home following stroke as well as the degree to which home time varies among discharging hospitals.
Methods: PROSPER is a PCORI-funded program designed with stroke survivors to evaluate post-stroke therapies and outcomes. We linked data for patients >65 years old who were enrolled in the GWTG-Stroke Registry to Medicare claims to ascertain home time, defined as time spent alive and out of a hospital or skilled nursing facility, at 90 days and 1 year after discharge for ischemic stroke. We used generalized mixed models with random effects to estimate adjusted mean home time for each hospital, accounting for patient characteristics. We then used linear regression to assess hospital factors associated with risk-adjusted home time.
Results: From 2007-2011, 156,869 ischemic stroke patients at 1417 hospitals were linked to Medicare claims. Home time varied among hospitals, with overall unadjusted median home time (IQR) of 59.5 days (55.7-63.2) over the first 90 days and 270 days (256.0-281.1) over the first year. Hospital factors associated with more home time over 90 days included higher annual stroke volume; South, West, or Midwest geographic regions (vs. Northeast); and rural location (Table). Similar patterns were observed at 1 year. Compared with patients in the highest hospital home time quartile, patients in the lowest were older, more likely to be female, had more comorbidities, and had more severe strokes by NIHSS. Home time variation decreased after adjustment, with a median of 59.3 days (57.4-61.4) over 90 days and 270 days (266.3-274.2) over 1 year.
Conclusions: In a population of older ischemic stroke survivors, home time after discharge varies by hospital stroke volume, severity case mix, and region. In adjusted analyses, hospital stroke volume and rural location were associated with more days at home following stroke.
Author Disclosures: E.C. O’Brien: Research Grant; Modest; Merck. Y. Xian: None. J. Wu: None. J.L. Saver: Consultant/Advisory Board; Modest; Covidien, Coaxia, Grifols, Brainsgate, Lundbeck, and St. Jude. E.E. Smith: Consultant/Advisory Board; Modest; Genentech, DSMB for MR WITNESS Trial. L.H. Schwamm: Consultant/Advisory Board; Modest; Lundbeck and Penumbra. E.D. Peterson: Research Grant; Modest; Lilly, Johnson & Johnson, Bristol-Myers Squibb, Sanofi-Aventis, and Merck-Schering Plough partnership. M.J. Reeves: None. D.L. Bhatt: Research Grant; Modest; Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Roche, Sanofi Aventis, The Medicines Company. Honoraria; Modest; American College of Cardiology (Editor, Clinical Trials, Cardiosource), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committe, Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Population Health Research Institute, Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (CME steering committees);. Consultant/Advisory Board; Modest; Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: AHA GWTG Steering CTTE;, Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute;. J. Prvu-Bettger: None. D. Hannah: None. L. Maisch: None. B. Lindholm: None. A.F. Hernandez: Research Grant; Modest; Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Novartis, Portola Pharmaceuticals. Honoraria; Modest; Amgen, GlaxoSmithKline, Janssen and Novartis. G.C. Fonarow: Consultant/Advisory Board; Modest; Medtronic, Amgen, Johnson & Johnson, Bayer, Boston Scientific. Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Novartis.
- © 2015 by American Heart Association, Inc.