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Joundi RA, Hill MD, Stang J, Nicol D, Yu AYX, Kapral MK, King JA, Halabi ML, Smith EE. Association Between Time to Treatment With Endovascular Thrombectomy and Home-Time After Acute Ischemic Stroke. Neurology 2024; 102:e209454. [PMID: 38848515 DOI: 10.1212/wnl.0000000000209454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Home-time is a patient-prioritized stroke outcome that can be derived from administrative data linkages. The effect of faster time-to-treatment with endovascular thrombectomy (EVT) on home-time after acute stroke is unknown. METHODS We used the Quality Improvement and Clinical Research registry to identify a cohort of patients who received EVT for acute ischemic stroke between 2015 and 2022 in Alberta, Canada. We calculated days at home in the first 90 days after stroke. We used ordinal regression across 6 ordered categories of home-time to evaluate the association between onset-to-arterial puncture and higher home-time, adjusting for age, sex, rural residence, NIH Stroke Scale, comorbidities, intravenous thrombolysis, and year of treatment. We used restricted cubic splines to assess the nonlinear relationship between continuous variation in time metrics and higher home-time, and also reported the adjusted odds ratios within time categories. We additionally evaluated door-to-puncture and reperfusion times. Finally, we analyzed home-time with zero-inflated models to determine the minutes of earlier treatment required to gain 1 day of home-time. RESULTS We had 1,885 individuals in our final analytic sample. There was a nonlinear increase in home-time with faster treatment when EVT was within 4 hours of stroke onset or 2 hours of hospital arrival. There was a higher odds of achieving more days at home when onset-to-puncture time was <2 hours (adjusted odds ratio 2.36, 95% CI 1.77-3.16) and 2 to <4 hours (1.37, 95% CI 1.11-1.71) compared with ≥6 hours, and when door-to-puncture time was <1 hour (aOR 2.25, 95% CI 1.74-2.90), 1 to <1.5 hours (aOR 1.89, 95% CI 1.47-2.41), and 1.5 to <2 hours (1.35, 95% CI 1.04-1.76) compared with ≥2 hours. Results were consistent for reperfusion times. For every hour of faster treatment within 6 hours of stroke onset, there was an estimated increase in home-time of 4.7 days, meaning that approximately 1 day of home-time was gained for each 12.8 minutes of faster treatment. DISCUSSION Faster time-to-treatment with EVT for acute stroke was associated with greater home-time, particularly within 4 hours of onset-to-puncture and 2 hours of door-to-puncture time. Within 6 hours of stroke onset, each 13 minutes of faster treatment is associated with a gain of 1 day of home-time.
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Affiliation(s)
- Raed A Joundi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Michael D Hill
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Jillian Stang
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Dana Nicol
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Amy Ying Xin Yu
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Moira K Kapral
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - James A King
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Mary-Lou Halabi
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
| | - Eric E Smith
- From the Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Ontario; Departments of Clinical Neurosciences (M.D.H., E.E.S.) and Community Health Sciences (E.E.S.), Cumming School of Medicine, University of Calgary; Data and Analytics (DnA) (J.S., D.N.) and Cardiovascular Health and Stroke Strategic Clinical Network (M.-L.H.), Alberta Health Services; ICES (A.Y.X.Y., M.K.K.), Toronto; Department of Medicine (Neurology) (A.Y.X.Y.), University of Toronto; Sunnybrook Health Sciences Centre (A.Y.X.Y.), Ontario; Department of Medicine (A.Y.X.Y.), Division of Neurology, University of Toronto; Department of Medicine (General Internal Medicine) (M.K.K.), University of Toronto-University Health Network, Ontario; Alberta Strategy for Patient Oriented Research Support Unit Data Platform (J.A.K.); and Provincial Research Data Services (J.A.K.), Alberta Health Services, Canada
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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Yu AYX, Kapral MK, Smith EE. Age-Specific Association of Co-Morbidity With Home-Time After Acute Stroke. Can J Neurol Sci 2024:1-9. [PMID: 38532570 DOI: 10.1017/cjn.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To examine the association of co-morbidity with home-time after acute stroke and whether the association is influenced by age. METHODS We conducted a province-wide study using linked administrative databases to identify all admissions for first acute ischemic stroke or intracerebral hemorrhage between 2007 and 2018 in Alberta, Canada. We used ischemic stroke-weighted Charlson Co-morbidity Index of 3 or more to identify those with severe co-morbidity. We used zero-inflated negative binomial models to determine the association of severe co-morbidity with 90-day and 1-year home-time, and logistic models for achieving ≥ 80 out of 90 days of home-time, assessing for effect modification by age and adjusting for sex, stroke type, comprehensive stroke center care, hypertension, atrial fibrillation, year of study, and separately adjusting for estimated stroke severity. We also evaluated individual co-morbidities. RESULTS Among 28,672 patients in our final cohort, severe co-morbidity was present in 27.7% and was associated with lower home-time, with a greater number of days lost at younger age (-13 days at age < 60 compared to -7 days at age 80+ years for 90-day home-time; -69 days at age < 60 compared to -51 days at age 80+ years for 1-year home-time). The reduction in probability of achieving ≥ 80 days of home-time was also greater at younger age (-22.7% at age < 60 years compared to -9.0% at age 80+ years). Results were attenuated but remained significant after adjusting for estimated stroke severity and excluding those who died. Myocardial infarction, diabetes, and cancer/metastases had a greater association with lower home-time at younger age, and those with dementia had the greatest reduction in home time. CONCLUSION Severe co-morbidity in acute stroke is associated with lower home-time, more strongly at younger age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - James A King
- Provincial Research Data Services, Alberta Health Services, Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy Y X Yu
- ICES, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moira K Kapral
- ICES, Toronto, ON, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric E Smith
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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External validation of the Passive Surveillance Stroke Severity Indicator. Neurol Sci 2022; 50:399-404. [PMID: 35478064 DOI: 10.1017/cjn.2022.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Passive Surveillance Stroke Severity (PaSSV) Indicator was derived to estimate stroke severity from variables in administrative datasets but has not been externally validated. METHODS We used linked administrative datasets to identify patients with first hospitalization for acute stroke between 2007-2018 in Alberta, Canada. We used the PaSSV indicator to estimate stroke severity. We used Cox proportional hazard models and evaluated the change in hazard ratios and model discrimination for 30-day and 1-year case fatality with and without PaSSV. Similar comparisons were made for 90-day home time thresholds using logistic regression. We also linked with a clinical registry to obtain National Institutes of Health Stroke Scale (NIHSS) and compared estimates from models without stroke severity, with PaSSV, and with NIHSS. RESULTS There were 28,672 patients with acute stroke in the full sample. In comparison to no stroke severity, addition of PaSSV to the 30-day case fatality models resulted in improvement in model discrimination (C-statistic 0.72 [95%CI 0.71-0.73] to 0.80 [0.79-0.80]). After adjustment for PaSSV, admission to a comprehensive stroke center was associated with lower 30-day case fatality (adjusted hazard ratio changed from 1.03 [0.96-1.10] to 0.72 [0.67-0.77]). In the registry sample (N = 1328), model discrimination for 30-day case fatality improved with the inclusion of stroke severity. Results were similar for 1-year case fatality and home time outcomes. CONCLUSION Addition of PaSSV improved model discrimination for case fatality and home time outcomes. The validity of PASSV in two Canadian provinces suggests that it is a useful tool for baseline risk adjustment in acute stroke.
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The Allure of Big Data to Improve Stroke Outcomes: Review of Current Literature. Curr Neurol Neurosci Rep 2022; 22:151-160. [PMID: 35274192 PMCID: PMC8913242 DOI: 10.1007/s11910-022-01180-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To critically appraise literature on recent advances and methods using "big data" to evaluate stroke outcomes and associated factors. RECENT FINDINGS Recent big data studies provided new evidence on the incidence of stroke outcomes, and important emerging predictors of these outcomes. Main highlights included the identification of COVID-19 infection and exposure to a low-dose particulate matter as emerging predictors of mortality post-stroke. Demographic (age, sex) and geographical (rural vs. urban) disparities in outcomes were also identified. There was a surge in methodological (e.g., machine learning and validation) studies aimed at maximizing the efficiency of big data for improving the prediction of stroke outcomes. However, considerable delays remain between data generation and publication. Big data are driving rapid innovations in research of stroke outcomes, generating novel evidence for bridging practice gaps. Opportunity exists to harness big data to drive real-time improvements in stroke outcomes.
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Association between Palliative Care, Days at Home, and Health Care Use in Patients with Advanced COPD: A Cohort Study. Ann Am Thorac Soc 2021; 19:48-57. [PMID: 34170780 DOI: 10.1513/annalsats.202007-859oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Palliative care focuses on improving quality of life for patients with life-limiting conditions. While previous studies have shown palliative care to be associated with reduced acute health care use in people with cancer and other illnesses, these findings may not generalize to patients with COPD. OBJECTIVES We examined the association between palliative care and rates of days at home, location of death, and acute health care use in patients with COPD. METHODS We used health administrative databases in Ontario, Canada to identify patients with advanced COPD hospitalized between April 2010 and March 2017 and followed until March 2018. Patients who received palliative care were matched 1:1 to those who did not on age, sex, long-term oxygen, previous COPD hospitalizations and propensity scores. Rate ratios (RR) were estimated using Poisson models with generalized estimating equations to account for matching. RESULTS Among 35,492 patients, 1,788 (5%) received palliative care. In the matched cohort (1,721 pairs), people with COPD receiving palliative care had similar rates of days at home (RR=1.01, 95% CI [0.97, 1.05]) but were more likely to die at home (16.4% vs. 10.0%, p<0.001) compared to those who did not receive palliative care. Rates of healthcare utilization were similar except for increased hospitalizations in the palliative care group (RR=1.09, 95% CI [1.01, 1.18]). CONCLUSIONS Receipt of palliative care did not reduce days at home or healthcare utilization but was associated with a modest increase in proportion dying at home. Future work should evaluate palliative care strategies designed specifically for patients with COPD.
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Fernando SM, Qureshi D, Talarico R, Tanuseputro P, Dowlatshahi D, Sood MM, Smith EE, Hill MD, McCredie VA, Scales DC, English SW, Rochwerg B, Kyeremanteng K. Intracerebral Hemorrhage Incidence, Mortality, and Association With Oral Anticoagulation Use: A Population Study. Stroke 2021; 52:1673-1681. [PMID: 33685222 DOI: 10.1161/strokeaha.120.032550] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke associated with significant morbidity and mortality. Recent epidemiological data on incidence, mortality, and association with oral anticoagulation are needed. METHODS Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (April 1, 2009-March 30, 2019). We captured outcome data using linked health administrative databases. The primary outcome was mortality during hospitalization, as well as at 1 year following ICH. RESULTS We included 20 738 patients with ICH. Mean (SD) age was 71.3 (15.1) years, and 52.6% of patients were male. Overall incidence of ICH throughout the study period was 19.1/100 000 person-years and did not markedly change over the study period. In-hospital and 1-year mortality were high (32.4% and 45.4%, respectively). Mortality at 2 years was 49.5%. Only 14.5% of patients were discharged home independently. Over the study period, both in-hospital and 1-year mortality reduced by 10.4% (37.5% to 27.1%, P<0.001) and 7.6% (50.0% to 42.4%, P<0.001), respectively. Use of oral anticoagulation was associated with both in-hospital mortality (adjusted odds ratio 1.37 [95% CI, 1.26-1.49]) and 1-year mortality (hazard ratio, 1.18 [95% CI, 1.12-1.25]) following ICH. CONCLUSIONS Both short- and long-term mortality have decreased in the past decade. Most survivors from ICH are likely to be discharged to long-term care. Oral anticoagulation is associated with both short- and long-term mortality following ICH. These findings highlight the devastating nature of ICH, but also identify significant improvement in outcomes over time.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,Department of Emergency Medicine (S.M.F.), University of Ottawa, ON, Canada
| | - Danial Qureshi
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Bruyère Research Institute, Ottawa, ON, Canada (D.Q., P.T.)
| | - Robert Talarico
- ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Peter Tanuseputro
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine (P.T., K.K.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Bruyère Research Institute, Ottawa, ON, Canada (D.Q., P.T.)
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Neurology, Department of Medicine (D.D.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Manish M Sood
- School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Division of Nephrology, Department of Medicine (M.M.S.), University of Ottawa, ON, Canada.,ICES, Toronto, ON, Canada (D.Q., R.T., P.T., M.M.S., P.T.).,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Eric E Smith
- Calgary Stroke Program, Hotchkiss Brain Institute (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michael D Hill
- Calgary Stroke Program, Hotchkiss Brain Institute (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada.,Department of Clinical Neurosciences (E.E.S., M.D.H.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Victoria A McCredie
- Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (V.A.M., D.C.S.).,Krembil Research Institute, Toronto Western Hospital, University Health Network, ON, Canada (V.A.M.).,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.)
| | - Damon C Scales
- Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada (V.A.M., D.C.S.).,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.).,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (D.C.S.)
| | - Shane W English
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,School of Epidemiology and Public Health (D.Q., P.T., D.D., M.M.S., S.W.E.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.)
| | - Bram Rochwerg
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (V.A.M., D.C.S.).,Department of Medicine, Division of Critical Care (B.R.), McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine (S.M.F., S.W.E., K.K.), University of Ottawa, ON, Canada.,Division of Palliative Care, Department of Medicine (P.T., K.K.), University of Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada (D.Q., R.T., P.T., D.D., M.M.S., S.W.E., K.K.).,Institut du Savoir Montfort, Ottawa, ON, Canada (K.K.)
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Gattellari M, Goumas C, Jalaludin B, Worthington J. Measuring stroke outcomes for 74 501 patients using linked administrative data: System-wide estimates and validation of 'home-time' as a surrogate measure of functional status. Int J Clin Pract 2020; 74:e13484. [PMID: 32003055 DOI: 10.1111/ijcp.13484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/20/2020] [Accepted: 01/27/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS Administrative data offer cost-effective, whole-of-population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke ('home-time') is a patient-centred outcome that can be objectively ascertained from administrative data. Population-based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative 'home-time' estimates and validate 'home-time' as a surrogate measure of functional status after stroke. METHODS Stroke hospitalisations from a state-wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90-day 'home-time' with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of 'home-time'. RESULTS Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median 'home-time' was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with 'home-time' (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased 'home-time' after ischaemic stroke and subarachnoid haemorrhage. CONCLUSIONS These findings underscore the immediate and adverse impact of stroke. 'Home-time' measured using administrative data is a robust, replicable and valid patient-centred outcome enabling inexpensive population-based surveillance and system-wide quality assessment.
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Affiliation(s)
- Melina Gattellari
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Chris Goumas
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, NSW, Australia
- School of Public Health, The University of New South Wales, Sydney, NSW, Australia
| | - John Worthington
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
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Gattellari M, Worthington JM. Letter by Gattellari and Worthington Regarding Article, "Deriving a Passive Surveillance Stroke Severity Indicator From Routinely Collected Administrative Data: The PaSSV Indicator". Circ Cardiovasc Qual Outcomes 2020; 13:e006613. [PMID: 32466728 DOI: 10.1161/circoutcomes.120.006613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Melina Gattellari
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John Mark Worthington
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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