Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Abstract

Background and Purpose— Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. Methods— Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0–2) was assessed by c -index. Results— There were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70–82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2–7]) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52–86) days and 349 (IQR, 303–360) days and median mRS were 2 (IQR, 1–4) and 2 (IQR, 1–4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient, −0.731; P <0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 ( c -index, 0.837). Similar findings were observed at 1 year. Conclusions— In a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.