Abstract 269: Does Functional Recovery After Stroke Vary by Hospital Type?
Background: Functional recovery following an acute ischemic stroke is a highly important outcome from a patient’s perspective. Whether functional outcomes following stroke vary among treating hospitals is unknown.
Methods: We examined 3 month functional recovery measured by the modified Rankin Scale (mRS) among 2,076 ischemic stroke patients treated at 82 U.S. hospitals in the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) study and Get With The Guidelines-Stroke registry. We used multivariable hierarchical models to examine the association of hospital characteristics (number of beds, region, academic/teaching center, annual ischemic stroke discharges, primary stroke center certification, hospitals’ composite score indicating stroke quality of care) and the outcome after adjusting for patient characteristics (socio-demographics and clinical factors including stroke severity as measured by the NIHSS). Rankin scores were classified as moderate-severe disability (mRS 3-5) vs. minor to no disability (mRS <2) and evaluated as continuous scores.
Results: Overall by 3 months after discharge, 35.9% of stroke patients had moderate-severe disability. Rates of moderate-severe disability varied by treating hospital (Figure) (mean 36%, IQR 26%-45%). Patients cared for in a teaching hospital (adjusted OR 0.71, 95% CI 0.52-0.96) or primary stroke center certified hospital (adjusted OR 0.69, 95% CI 0.51-0.93) were significantly less likely to have moderate-severe disability at 3 months. Relative to the Northeast, care in hospitals in the Midwest or South was associated with higher likelihood moderate-severe disability (OR 1.45, 95% CI 1.04-2.03 and OR 1.57, 95% CI 1.06-2.30, respectively). In contrast, functional outcomes did not vary by hospital stroke care quality, stroke volume, or hospital bed size. Findings were similar for mRS as a continuous outcome.
Conclusions: A third of acute ischemic stroke patients had moderate-severe disability three months after hospital discharge and these rates varied considerably among U.S. hospitals. Receiving stroke care at a teaching or primary stroke center hospital was associated with significantly better post discharge functional status.
Author Disclosures: J. Prvu Bettger: None. L. Liang: None. L. Thomas: None. C. Bushnell: None. Y. Xian: None. J. Wu: None. E.D. Peterson: None.
- © 2014 by American Heart Association, Inc.