Abstract P34: Hospital Level Variation in Clinical Outcomes for Medicare Beneficiaries Hospitalized With Ischemic Stroke

Abstract

Background: Mortality and readmission rates after hospitalization for stroke are being considered as metrics of hospital-level quality of care for Medicare beneficiaries. To date, little is known about ischemic stroke mortality and readmission rates at the hospital level and how they vary. Methods: We analyzed data from 91,134 Medicare fee-for-service beneficiaries enrolled from 625 Get With The Guidelines-Stroke hospitals between April 2003 and December 2006, which were linked to longitudinal outcome data from CMS. Hospitals with fewer than 25 ischemic stroke patients were excluded. Within each hospital, 30-day, 90-day, and 1 year, death or all-cause readmission rates were calculated with and without risk adjustment. Results: There was a median 102 ischemic stroke patients per hospital (25 th -75 th 54 to 199). In this cohort mean age was 79.4 years, 58% were female, and 81% were white. Prior stroke/TIA was present in 32%, atrial fibrillation/flutter in 24%, diabetes in 28%, and hypertension in 77%. In-hospital mortality was 6.1%; the majority of deaths occurred following discharge (table). More than one in five ischemic stroke patients had death or rehospitalization within 30 days of hospital discharge and nearly two-thirds within 1 year. Risk adjusted rates varied widely by hospital at each time point. Conclusions: Hospital-level rates of death or readmission following an ischemic stroke hospitalization are high and vary considerably. Further research is needed to determine preventable causes of rehospitalizations and improve early, intermediate, and long-term outcomes. Hospital Level Variation in Clinical Outcomes for Ischemic Stroke Clinical Outcomes, Risk Adjusted Mean ± STD 10 th 25 th Median 75 th 90 th Death (all admissions) In-Hospital 6.1 ± 3.5% 2.3% 3.7% 5.8% 7.8% 10.6% 30-Day (after admission) 14.2 ± 4.7% 8.6% 11.3% 14.0% 16.6% 19.9% Death (among hospital survivors) 30-Day (after discharge) 10.0 ± 4.3% 5.1% 7.1% 9.7% 12.0% 15.6% 90-Day (after discharge) 15.7 ± 5.0% 9.7% 12.7% 15.3% 18.3% 21.9% 1-Year (after discharge) 26.7 ± 6.0% 19.2% 23.2% 26.5% 29.9% 34.2% Rehospitalization 30-Day 14.5 ± 5.0% 8.5% 11.3% 14.3% 17.3% 20.7% 90-Day 29.8 ± 6.5% 22.2% 25.6% 29.8% 33.8% 37.8% 1-Year 56.2 ± 7.2% 47.8% 51.5% 55.9% 61.2% 64.8% Death or Rehospitalization 30-Day (after discharge) 21.5 ± 5.8% 14.8% 18.0% 21.5% 24.8% 28.7% 90-Day (after discharge) 37.2 ± 6.6% 29.3% 33.2% 37.2% 40.7% 45.5% 1-Year (after discharge) 61.9 ± 6.6% 53.9% 57.7% 61.9% 66.4% 69.9%