Background: Non-interventional large-scale research on patients with stroke requires the use of data sources ensuring access to large populations with clinically detailed and longitudinally available real-world healthcare information. We linked the Paul Coverdell National Acute Stroke Program registry (PCNASP) to commercial longitudinal claims data to assess long-term medication adherence post discharge. Methods: All ischemic stroke (IS) admissions in PCNASP between 2008-2015 were considered for linkage to longitudinal patient claims records from a commercial health insurer using a probabilistic algorithm. We assessed the linkage quality via the percentage of unique records among the linked subset, evaluated the representativeness of the linked population via standardized differences (SD), and described medical history, stroke severity and disability, and patterns of medication use before and after the stroke hospitalization among linked patients. Results: The linkage produced uniqueness equal to 99.1%. Overall, we linked 5,644 out of 104,540 patients with an IS hospitalization in claims data. Linked patients were similar to unlinked except for mean age (69.7 vs 72.5 yr, SD 0.23) and % home discharge (59.8 vs. 52.2, SD 0.14) with mild strokes (median NIHSS 3). Medication information from the PCNASP registry often differed from claims-based out-of-hospital drug utilization patterns, particularly after discharge, with prescriptions at discharge largely overestimating the real-world use of medications as measured by filled prescriptions. (Table) Conclusions: In a large cohort of hospitalized IS patients, high-quality probabilistic linkage between the PCNASP stroke registry and commercial claims data is feasible. Differences between predicted and actual post discharge medication utilization highlight the challenges of assuming long-term medication adherence based on discharge prescriptions. Further research is warranted.
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