Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals

Thompson, Michael P.; Zhao, Xin; Bekelis, Kimon; Gottlieb, Daniel J.; Fonarow, Gregg C.; Schulte, Phillip J.; Xian, Ying; Lytle, Barbara L.; Schwamm, Lee H; Smith, Eric E.; Reeves, Mathew J.

doi:10.1161/circoutcomes.117.003604

Cited by 16 publications

(11 citation statements)

References 47 publications

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“…The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a mean value of 10.66% (SD 6.87%). The results varied across countries and regions, with the highest reported 30-day readmission rate from China (11) and the lowest from the United States (12), which is consistent with the results of previous systematic reviews and meta-analyses (2,4,7,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Many risk factors can contribute to 30-day readmission in patients with ischemic stroke.…”

Section: Discussionsupporting

confidence: 87%

Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis

Deng¹,

Wu²,

Hu³

et al. 2021

Ann Palliat Med

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Background: The aim of this study was to identify risk factors for 30-day readmission in ischemic stroke survivors, with an attempt to improve post-discharge care and lower the 30-day readmission rate.Methods: Seven databases were searched from inception to April 30, 2021. Retrospective or prospective observational studies and interventional studies focusing on 30-day readmission risk factors in patients with ischemic stroke were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale (NOS). The pooled effect size was estimated using the odds ratio (OR), and the corresponding 95% confidence interval (CI) was calculated. The Cochrane Q (χ 2 ) and I 2 tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed-or random-effects models.Results: A total of 17 retrospective observational studies from the United States (n=10), China (n=2), Republic of Korea (n=2), Norway (n=2), and Australia (n=1), comprising a total of 1,829,964 patients, were included. The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a

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Section: Discussionsupporting

confidence: 87%

Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis

Deng¹,

Wu²,

Hu³

et al. 2021

Ann Palliat Med

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“…In a recent report, the Centers for Disease Control called for further evaluation of system-level factors that may result in variation in stroke outcomes (Adeoye et al, 2019; Centers for Disease Control and Prevention, 2018). In the few studies examining system-level factors, investigators have focused on the availability of stroke physician specialists and stroke center status (Doyle et al, 2013;Okere et al, 2016;Shkirkova et al, 2020;Thompson et al, 2017). Nurses are an integral part of health care systems and provide around the clock monitoring and management to stroke patients, though few investigators have examined nursing's influence on stroke outcomes (Camicia & Lutz, 2016;Summers et al, 2009).…”

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confidence: 99%

Better nurse work environments associated with fewer readmissions and shorter length of stay among adults with ischemic stroke: A cross‐sectional analysis of United States hospitals

Brom

Carthon

Sloane

et al. 2021

Research in Nursing & Health

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Stroke is among the most common reasons for disability and death. Avoiding readmissions and long lengths of stay among ischemic stroke patients has benefits for patients and health care systems alike. Although reduced readmission rates among a variety of medical patients have been associated with better nurse work environments, it is unknown how the work environment might influence readmissions and length of stay for ischemic stroke patients. Using linked data sources, we conducted a cross-sectional analysis of 543 hospitals to evaluate the association between the nurse work environment and readmissions and length of stay for 175,467 hospitalized adult ischemic stroke patients. We utilized logistic regression models for readmission to estimate odds ratios (OR) and zero-truncated negative binomial models for length of stay to estimate the incident-rate ratio (IRR). Final models accounted for hospital and patient characteristics. Seven and 30-day readmission rates were 3.9% and 10.1% respectively and the average length of stay was 4.9 days. In hospitals with better nurse work environments ischemic stroke patients experienced lower odds of 7-and 30-day readmission (7-day OR, 0.96; 95% confidence interval [CI]: 0.93-0.99 and 30-day OR, 0.97; 95% CI: 0.94-0.99) and lower length of stay (IRR, 0.97; 95% CI: 0.95-0.99). The work environment is a modifiable feature of hospitals that should be considered when providing comprehensive stroke care and improving post-stroke outcomes.ischemic stroke, length of stay, nurse work environment, readmissionGlobally, stroke is the second highest cause of death and third highest reason for disability (Benjamin et al., 2017;Gorelick, 2019). Despite acute stroke management being highly protocolized, variation still exists with regard to patient outcomes (Kaufman et al., 2019;Messé et al., 2016). For example, readmission rates among stroke patients are as high as 13% with most readmissions being unplanned and many avoidable (Bambhroliya et al., 2018;Vahidy et al., 2017).Variations in outcomes, including readmissions and length of stay, have been attributed to patient factors, including age and underlying general health (

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“…In accordance with previous studies, the size and direction of the effect of center type and center size remained unclear. 2,3,5 Possibly, other, not included patient characteristics, such as the Alberta Stroke Program Early Computed Tomography score or collateral score, may have differed between large and small EVT centers or between centers types. Also, the number of EVTs per interventionalist was not included in our analysis, let alone their competence in the intervention.…”

Section: Discussionmentioning

confidence: 99%

Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries

Janssen

Overhagen

Vinklárek

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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Background: Insight in differences in patient outcomes between endovascular thrombectomy (EVT) centers can help to improve stroke care. We assessed between-center variation in functional outcome of patients with acute ischemic stroke who were treated with EVT. We analyzed to what extent this variation may be explained by modifiable center characteristics. Methods: We used nationwide registry data of patients with stroke treated with EVT in the Netherlands and in the Czech Republic. Primary outcome was modified Rankin Scale score at 90 days as an indicator of disability. We used multilevel ordinal logistic regression to quantify the between-center variation in outcomes and the impact of patient and center characteristics. Between-center variation was expressed as the relative difference in odds of a more favorable modified Rankin Scale score between a relatively better performing center (75th percentile) and a relatively worse performing center (25th percentile). Results: We included a total of 4518 patients treated in 33 centers. Adjusted for patient characteristics, the odds of a more favorable outcome in a center at the 75th percentile of the outcome distribution were 1.46 times higher (95% CI, 1.31–1.70) than the odds in a center at the 25th percentile. Adjustment for center characteristics, including the median time between stroke onset and reperfusion per center, decreased this relative difference in odds to 1.30 (95% CI, 1.18–1.50, P =0.01). This translates into an absolute difference in likelihood of good functional outcome of 8% after adjustment for patient characteristics and to 5% after further adjustment for modifiable center characteristics. Conclusions: The considerable between-center variation in patient outcomes after EVT for acute ischemic stroke could be largely explained by center-specific characteristics, such as time to reperfusion. Improvement of these parameters may likely result in a decrease in center-specific differences, and an overall improvement in outcome of patients with acute ischemic stroke.

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Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines–Stroke Hospitals

Cited by 16 publications

References 47 publications

Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis

Risk factors for 30-day readmission in patients with ischemic stroke: a systematic review and meta-analysis

Better nurse work environments associated with fewer readmissions and shorter length of stay among adults with ischemic stroke: A cross‐sectional analysis of United States hospitals

Between-Center Variation in Outcome After Endovascular Treatment of Acute Stroke: Analysis of Two Nationwide Registries

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