Hospital Variation in Functional Recovery After Stroke

Abstract

Background-Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes. Methods and Results-Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic StrokeLongitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses. Conclusions-One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes. (Circ Cardiovasc Qual Outcomes.

Clinical and biochemical predictors of late-outcome in patients after ischemic stroke

“…Predicting late recovery 3 months after the onset of IS remains difficult because of factors such as co-morbidities, social environment and personality traits, which additionally co-influence patients with a neurological state. Functional recovery rates varied considerably among hospitals [3].…”

“…Accurate prognosis concerning the outcome can help to plan the rehabilitation process and determine the need for care of caregivers. Many factors including demographic features, clinical scales and biochemical parameters have been assessed until the present according to their usefulness as predictors [1,2,3].…”

Hospital Discharge Disposition of Stroke Patients in Tennessee

“…This may be an important confounder for our findings because other investigators have shown significant variability in stroke outcomes by hospital facility, where teaching hospitals and certified stroke centers reported better stroke outcomes compared with community hospitals. 39 …”

Low Cost Soft Robotic Gloves for At-home Rehabilitation and Daily Living Activities

“…According to World Health Organization, Kazakhstan has the highest ratio of stroke patients per 100,000 while gulf countries have lowest per 100,000 people [5]. There is high chance of impairment in these patients as compared to death [6]. 60% of the stroke patients do not fully recover at 3 to 6 months after stroke attack [7].…”