A recent study, published in the December 16, 2010 issue of Stroke, close to 2/3 medicare patients discharged from the hospital after suffering an ischemic stroke are readmitted, or die, within a year. The study also found that such post-discharge mortality and rehospitalization rates varied considerably between hospitals. The study showed that such variance was not dependent on the size of the institution or the size of its stroke center designation.
“The very high rates of death and rehospitalization are in a sense staggering, and despite some advances, stroke continues to place a burden on this patient population, which is fee-for-service Medicare beneficiaries. Also striking is the very substantial variation in clinical outcomes by hospitals.” – Dr Gregg Fonarow, Lead Author of the study, UCKA
The following lists some important details of the stroke treatment study:
- Study based on data from 91,134 Medicare beneficiaries between April 1, 2003 and December 31, 2006
- Median Age: 79.3 years
- Overall rate of death or rehospitalization within 12 months: 61.9%
- Difference in 30-day post-stroke mortality between 2003 and 2006: 0.1% (14.1% in 2003 vs. 14.2% in 2006)
- Academic hospitals performed marginally better than their nonacademic equivalents (variation of 2%-5%)
- Significant mortality and readmission variation between hospitals was discovered
Dr. Fonarow was unable to offer insight into why there was such great variance in outcomes between different hospitals
“Understanding what it is about what they’re doing is an important next step. It wasn’t something as simple as where the hospital was located or the number of beds they had; it was more around the processes they had and the systems they had in place, and those were variables we didn’t have access to in this study.”
The authors suggest that several areas of potential improvement exist in post-acute stroke care. These include:
- stroke severity measurements only documented in 37% of patients – possibly due to the the fact that they arrived by private transport rather than through emergency medical services
- more than half of the rehospitalizations were related to noncardiovascular causes, which leaves room for significant secondary prevention efforts