title: Transient ischaemic attack and ischaemic stroke: constructing episodes of care using hospital claims data.
abstract: BACKGROUND
  Stroke patients may have multiple hospital separations relating to the same stroke. Understanding the pattern of hospitalisations for these patients enables first and recurrent events to be distinguished to better understand care. The aim of this study was to investigate reasons for hospital separations after transient ischaemic attack (TIA) or ischaemic stroke and construct episode of care criteria.
  
  
  METHODS
  A retrospective observational study was conducted using the Australian Government Department of Veterans' Affairs administrative claims database. All patients hospitalised for TIA or ischaemic stroke in 2008-2009 were included. Reasons for hospital separations in the 60 days after TIA or ischaemic stroke were classified by a clinical panel as 'probably', 'possibly' or 'unlikely' to be related to the index separation. Based on panel assessment and time between separations, episode of care criteria for TIA and ischaemic stroke were constructed.
  
  
  RESULTS
  Of the 4520 veterans alive after the index separation, 32% of TIA patients (n=782) and 63% of ischaemic stroke patients (n=1323) had another separation within 60 days. The clinical panel reviewed 460 unique reasons for readmission. Of the 3263 separations, 55% and 85% were classified as related to the index TIA and ischaemic stroke separation, respectively.
  
  
  CONCLUSIONS
  Patients hospitalised for ischaemic stroke are likely to have multiple hospital separations for treatment of the same event. Multiple separations for treatment of TIA were less frequent. Consideration of these related separations is recommended when assessing health service utilisation from claims databases.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. janet.sluggett@mymail.unisa.edu.au
authors.forename: Janet K
authors.initials: JK
authors.lastname: Sluggett
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Caughey
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ward
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016208:Databases, Factual; D017050:Episode of Care; D005260:Female; D006760:Hospitalization; D006801:Humans; D007345:Insurance Claim Review; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D010359:Patient Readmission; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*
references.citation: Am J Cardiol. 1993 Jul 1;72(1):26-30
references.pmid: 8517424
references.citation: Med Care. 2006 Nov;44(11):1011-9
references.pmid: 17063133
references.citation: Pharmacoepidemiol Drug Saf. 2001 Aug-Sep;10(5):417-27
references.pmid: 11802588
references.citation: Stroke. 2005 Aug;36(8):1776-81
references.pmid: 16020772
references.citation: Cerebrovasc Dis. 2009;28(2):105-11
references.pmid: 19506368
references.citation: Home Health Care Serv Q. 2007;26(4):37-55
references.pmid: 18032199
references.citation: Stroke. 2004 Aug;35(8):1925-9
references.pmid: 15192248
references.citation: Stroke. 2008 Oct;39(10):2727-31
references.pmid: 18658031
references.citation: Intern Med J. 2013 Dec;43(12):1280-6
references.pmid: 23279612
references.citation: Can J Cardiol. 2006 Jan;22(1):65-71
references.pmid: 16450021
references.citation: Pharmacoepidemiol Drug Saf. 2012 Jan;21 Suppl 1:100-28
references.pmid: 22262598
references.citation: J Aging Health. 1999 Feb;11(1):27-48
references.pmid: 10848140
references.citation: Am J Manag Care. 2006 Jun;12(6):313-9
references.pmid: 16756450
references.citation: Rural Remote Health. 2010 Apr-Jun;10(2):1447
references.pmid: 20536269
references.citation: Lancet Neurol. 2010 Jan;9(1):105-18
references.pmid: 20083041
references.citation: BMC Med Res Methodol. 2012 Sep 03;12:133
references.pmid: 22943606
references.citation: Cerebrovasc Dis. 2011;32(4):370-82
references.pmid: 21921601
references.citation: Stroke. 2000 Sep;31(9):2087-92
references.pmid: 10978034
references.citation: Lancet Neurol. 2007 Dec;6(12):1063-72
references.pmid: 17993293
references.citation: J Stroke Cerebrovasc Dis. 2005 Jul-Aug;14(4):145-51
references.pmid: 17904016
references.citation: Med Care. 1994 Jul;32(7 Suppl):JS38-51
references.pmid: 8028412