Fonarow Gregg C, Liang Li, Thomas Laine, Xian Ying, Saver Jeffrey L, Smith Eric E, Schwamm Lee H, Peterson Eric D, Hernandez Adrian F, Duncan Pamela W, O'Brien Emily C, Bushnell Cheryl, Prvu Bettger Janet
From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
Stroke. 2016 Mar;47(3):836-42. doi: 10.1161/STROKEAHA.115.011599.
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.
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.
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.
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.
卒中幸存者将在家时间视为一项有意义的预后指标。我们将在家时间作为以患者为中心的预后指标，在医保受益的缺血性卒中患者中进行评估，并与发病后90天及1年时的改良Rankin量表（mRS）评分进行比较。
纳入“遵循卒中指南（GWTG - 卒中）”和“缺血性卒中后纵向依从性评估（AVAIL）”登记研究的患者与医保理赔数据相关联，以确定在家时间，即入院后90天及1年时存活且不在医院、住院康复机构或专业护理机构的时间。通过Pearson相关系数评估在家时间与90天及1年时mRS的相关性，并通过c指数评估在家时间区分mRS（0 - 2）的能力。
来自88家医院的815例缺血性卒中患者（年龄中位数76岁[四分位间距{IQR}，70 - 82]；46%为女性；美国国立卫生研究院卒中量表中位数4[IQR，2 - 7]）。90天和1年时在家时间的中位数分别为79（IQR，52 - 86）天和349（IQR，303 - 360）天，mRS中位数分别为2（IQR，1 - 4）和2（IQR，1 - 4）。90天内在家时间越长，与90天时较低的mRS显著相关（Pearson相关系数， - 0.731；P<0.0001），且在区分mRS为0至2的功能独立性方面表现出较强能力（c指数，0.837）。1年时观察到类似结果。
在老年缺血性卒中患者群体中，可从管理数据中轻易获取在家时间，且其与90天及1年时的mRS相关。在家时间代表了一种新颖、易于测量、以患者为中心的卒中治疗阶段预后指标。
