Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Fonarow, Gregg C.; Li, Liang; Thomas, Laine; Xian, Ying; Saver, Jeffrey L.; Smith, Eric E.; Schwamm, Lee H; Peterson, Eric D.; Hernandez, Adrian F.; Duncan, Pamela W.; O’Brien, Emily C.; Bushnell, Cheryl; Bettger, Janet Prvu

doi:10.1161/strokeaha.115.011599

Cited by 80 publications

(97 citation statements)

References 18 publications

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“…For most lay persons, interpretation of treatment effect, summarized as a gain or loss in home time, is more intuitive than relative risks or hazard ratios. For these reasons, home time has been examined in relation to mortality in heart failure [3][4][5] as well as global disability and modified Rankin score in stroke [6][7][8][9][10][11] in administrative claims data sets. For example, warfarin therapy in Medicare beneficiaries with atrial fibrillation who were hospitalized for ischemic stroke was associated with a 48-day gain in home time over 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the number of days alive and spent out of hospitals and skilled nursing facilities (SNFs) in a given time period, also known as "home time," has been proposed as a measure of quality of life. 2 Home time can be conveniently obtained from administrative claims data and has been endorsed by patients as a meaningful health outcome, [3][4][5][6][7][8][9][10][11] and it can be more intuitively understood. However, not all hospitalizations and SNF stays represent poor health or low quality of life in older adults.…”

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confidence: 99%

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Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Lee

Shi

Kim

2018

J American Geriatrics Society

131

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BACKGROUND Home time, the number of days alive and spent out of hospital and skilled nursing facility, has been proposed as a patient‐centered outcome that can be readily calculated in administrative claims data. OBJECTIVES To compare home time against existing patient‐centered outcome measures. DESIGN Retrospective cohort study. SETTING Community. PARTICIPANTS A total of 4594 Medicare beneficiaries 65 years or older with complete survey and claims data in the Medicare Current Beneficiary Survey 2010 to 2011. MEASUREMENTS Home time was calculated from the 2011 claims data (range, 0‐365 days). The 1‐year incidence of patient‐centered outcomes (poor self‐rated health, mobility impairment, depression, limited social activity, and difficulty in self‐care) was measured. The minimum clinically important difference (MCID) was derived by contrasting the mean home time between those who experienced functional decline or death and those who did not. RESULTS The mean home time was 355.8 days (SD, 42.1 days); 84.1% had a home time of 365 days, and 5.7% had a home time of 336 days or fewer. The incidence of poor self‐rated health ranged from 2% (home time, 365 days) to 21% (home time, less than 337 days). Similarly, the corresponding incidence risks were 11% to 59% for mobility impairment, 5% to 19% for depression, 17% to 67% for limited social activity, and 13% to 68% for difficulty in self‐care. The risk of mobility impairment, depression, and difficulty in self‐care increased steeply after home time loss of 15 days or greater. The MCID of home time was 18.6 days. CONCLUSION A loss in home time is associated with decline in several patient‐centered outcome measures in community‐dwelling Medicare beneficiaries. These results provide empirical evidence to promote adoption of home time and its clinical interpretation for database studies of medical interventions. J Am Geriatr Soc 67:347–351, 2019.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Lee

Shi

Kim

2018

J American Geriatrics Society

131

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“…It has been shown that patients with an mRS of 3 have significantly more time at home, thus reducing the need for rehabilitation and costs for society [23,24].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

et al. 2019

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Objectives: Endovascular treatment (EVT) has emerged as the gold standard therapy for stroke due to large vessel occlusion (LVO). There is however limited evidence to suggest that similar efficacy can be expected in elderly patients. We aimed to assess the efficacy and safety of EVT in elderly patients (aged > 80), comparing outcomes to younger patients (aged < 80). Material and Methods: A total of 195 patients with LVO stroke treated with EVT were included and dichotomized by age. We compared neurological improvement, clinical 90 day outcome, technical recanalization rates, procedure-related complications, and mortality in between the groups. Results: Both groups showed equally marked neurological improvement. A favorable outcome modified Rankin Scale (mRS < 2) was seen in 28% of the elderly patients compared to 46% of the younger patients (p = 0.01). mRS 0–3 was seen in 46% of the elderly patients and 58% of the younger patients (p = 0.09). The rates of successful technical recanalization did not differ between the groups and there were no differences in procedural complication rates or incidence of symptomatic intracranial bleeding. Three-month mortality rates were however higher in the elderly group. Conclusions: EVT in the elderly resulted in equally notable neurological improvement as compared to younger patients. Although the elderly had a higher mortality rate and fewer favorable clinical outcomes at 3 month follow-up, a strict upper age limit for EVT seems unjustified.

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“…with the modified Rankin Scale or the Barthel Index. [11][12][13][14][15]36,39,40 Here, we demonstrate a strong correlation with another measure of functional status, the FIM, adding weight to the construct validity of 'home-time'. Total FIM and motor subscale scores were strongly associated with 'home-time', whereas the correlation between cognitive subscale scores and days spent at home was more moderate.…”

Section: Previous Results Demonstrate That 'Home-time' Correlatesmentioning

confidence: 83%

“…'Home-time' measures the number of days spent at home after stroke onset, taking into account patient survival and days spent in hospital, reflecting a patient's capacity to return to their private residence after hospitalisation. [11][12][13][14][15] 'Home-time' therefore can be unobtrusively and objectively measured using routinely collected data that are linked to health records following stroke and is proposed as a patient-centred surrogate measure of functional status. 'Home-time' in stroke is often measured within 90 days of admission, [11][12][13][14][15] in keeping with the gold-standard follow-up period for clinical trials and epidemiological research.…”

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confidence: 99%

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

et al. 2020

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Aims Administrative data offer cost‐effective, whole‐of‐population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke (‘home‐time’) is a patient‐centred outcome that can be objectively ascertained from administrative data. Population‐based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative ‘home‐time’ estimates and validate ‘home‐time’ as a surrogate measure of functional status after stroke. Methods Stroke hospitalisations from a state‐wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90‐day ‘home‐time’ with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of ‘home‐time’. Results Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median ‘home‐time’ was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with ‘home‐time’ (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased ‘home‐time’ after ischaemic stroke and subarachnoid haemorrhage. Conclusions These findings underscore the immediate and adverse impact of stroke. ‘Home‐time’ measured using administrative data is a robust, replicable and valid patient‐centred outcome enabling inexpensive population‐based surveillance and system‐wide quality assessment.

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Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Cited by 80 publications

References 18 publications

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Home Time as a Patient‐Centered Outcome in Administrative Claims Data

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

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