Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get with the Guidelines-Stroke Hospitals

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background - We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. Methods and Results - This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation (r=-0.17; P=0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained. Conclusions - Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.

Original languageEnglish (US)
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Medicare
Stroke
Guidelines
Mortality
Referral and Consultation
Delivery of Health Care
Demography
Fee-for-Service Plans
Atlases
Quality of Health Care
Registries
Comorbidity
Linear Models

Keywords

  • ischemic stroke
  • medicare
  • outcomes
  • variation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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; Xian, Ying; Lytle, Barbara L.; Schwamm, Lee H.; Smith, Eric E.; Reeves, Mathew J.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 8, 01.08.2017.

Research output: Contribution to journalArticle

Thompson, Michael P. ; Zhao, Xin ; Bekelis, Kimon ; Gottlieb, Daniel J. ; Fonarow, Gregg C. ; Schulte, Phillip ; Xian, Ying ; Lytle, Barbara L. ; Schwamm, Lee H. ; Smith, Eric E. ; Reeves, Mathew J. / Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get with the Guidelines-Stroke Hospitals. In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 8.
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T1 - Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get with the Guidelines-Stroke Hospitals

AU - Thompson, Michael P.

AU - Zhao, Xin

AU - Bekelis, Kimon

AU - Gottlieb, Daniel J.

AU - Fonarow, Gregg C.

AU - Schulte, Phillip

AU - Xian, Ying

AU - Lytle, Barbara L.

AU - Schwamm, Lee H.

AU - Smith, Eric E.

AU - Reeves, Mathew J.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background - We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. Methods and Results - This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation (r=-0.17; P=0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained. Conclusions - Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.

AB - Background - We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. Methods and Results - This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation (r=-0.17; P=0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained. Conclusions - Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.

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