TY - JOUR
T1 - Rates of Adverse Events and Outcomes among Stroke Patients Admitted to Primary Stroke Centers
AU - Chaudhry, Saqib A.
AU - Afzal, Mohammad R.
AU - Chaudhry, Burhan Z.
AU - Zafar, Taqi T.
AU - Safdar, Adnan
AU - Kassab, Mounzer Y.
AU - Hussain, Syed I.
AU - Qureshi, Adnan I.
N1 - Publisher Copyright:
© 2016 National Stroke Association
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background and purpose To identify the beneficial effects of primary stroke centers (PSCs) certification by Joint Commission (JC), we compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States. Methods We obtained the data from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the Nationwide Inpatient Sample hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease, 9th Revision, codes 433.x1, 434.x1). Results We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted to PSCs. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to PSCs were at lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR],.8; 95% confidence interval [CI],.7-.8) and sepsis (OR,.7; 95% CI,.6-.8). Patients admitted to PSCs were more likely to receive thrombolysis (OR, 1.6; 95% CI, 1.5-1.7). The mean cost of hospitalization (95% CI) of the patients was significantly higher in patients admitted at PSCs compared with those admitted at non PSC hospitals $47621 (47099-48144) vs. $35229 (34803-35654), P < .0001). The patients admitted to PSCs had lower inpatient mortality (OR,.8; 95% CI,.8-.9) and were more likely to be discharged with none to minimal disability (OR, 1.1; 95% CI, 1.0-1.1). Conclusions Compared with non-PSC admissions, patients admitted to PSCs are less likely to experience hospital adverse events and more likely to experience better discharge outcomes.
AB - Background and purpose To identify the beneficial effects of primary stroke centers (PSCs) certification by Joint Commission (JC), we compared the rates of in-hospital adverse events and discharge outcomes among ischemic stroke patients admitted to PSCs and those admitted to non-PSC hospitals in the United States. Methods We obtained the data from the Nationwide Inpatient Sample from 2010 and 2011. The analysis was limited to states that publicly reported hospital identity. PSCs were identified by matching the Nationwide Inpatient Sample hospital files with the list provided by JC. The analysis was limited to patients (age ≥18 years) discharged with a principal diagnosis of ischemic stroke (International Classification of Disease, 9th Revision, codes 433.x1, 434.x1). Results We identified a total of 123,131 ischemic stroke patients from 28 states. A total of 72,982 (59.3%) patients were admitted to PSCs. After adjusting for age, gender, race or ethnicity, comorbidities, All Patients Refined Diagnosis Related Groups (APR-DRG)-based disease severity, and hospital teaching status, patients admitted to PSCs were at lower risk of in-hospital adverse events complications: pneumonia (odds ratio [OR],.8; 95% confidence interval [CI],.7-.8) and sepsis (OR,.7; 95% CI,.6-.8). Patients admitted to PSCs were more likely to receive thrombolysis (OR, 1.6; 95% CI, 1.5-1.7). The mean cost of hospitalization (95% CI) of the patients was significantly higher in patients admitted at PSCs compared with those admitted at non PSC hospitals $47621 (47099-48144) vs. $35229 (34803-35654), P < .0001). The patients admitted to PSCs had lower inpatient mortality (OR,.8; 95% CI,.8-.9) and were more likely to be discharged with none to minimal disability (OR, 1.1; 95% CI, 1.0-1.1). Conclusions Compared with non-PSC admissions, patients admitted to PSCs are less likely to experience hospital adverse events and more likely to experience better discharge outcomes.
KW - Ischemic stroke
KW - certified stroke center
KW - in-hospital adverse events
KW - outcomes
KW - primary stroke centers
KW - thrombolysis
UR - https://www.scopus.com/pages/publications/84969253196
UR - https://www.scopus.com/pages/publications/84969253196#tab=citedBy
U2 - 10.1016/j.jstrokecerebrovasdis.2016.01.045
DO - 10.1016/j.jstrokecerebrovasdis.2016.01.045
M3 - Article
C2 - 27209089
AN - SCOPUS:84969253196
SN - 1052-3057
VL - 25
SP - 1960
EP - 1965
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 8
ER -
