Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial.
OBJECTIVE
To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse.


METHODS
The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100).


RESULTS
One thousand six hundred four patients who were independent before stroke (mean age: 69.9+/-12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US).


CONCLUSIONS
Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.
Rundek
Tanja
T
Department of Neurology, Neurological Institute, Columbia University, New York, NY, USA.
Nielsen
Kirsten
K
Phillips
Stephen
S
Johnston
Karen C
KC
Hux
Marg
M
Watson
David
D
D000208:Acute Disease; D000359:Aftercare / Q000706:statistics & numerical data; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005998:Glycine / Q000037:antagonists & inhibitors; D018684:Glycine Agents / Q000627:therapeutic use*; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D000071939:Stroke Rehabilitation; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
C105319:3-(2-((phenylamino)carbonyl)ethenyl)-4,6-dichloroindole-2-carboxylic acid; D018684:Glycine Agents; D007211:Indoles; D018696:Neuroprotective Agents; D005998:Glycine