title: A case-control study of the effectiveness of tissue plasminogen activator on 6 month patients--reported outcomes and health care utilization.
abstract: We examined the benefit of tissue plasminogen activator (tPA), delivered as part of usual stroke management, on patient-reported outcomes and health care utilization. Using a case control design, patients who received tPA as part of usual stroke management were compared with patients who would have received tPA had they arrived to the hospital within the therapeutic time window. Data were collected from surveys 6 months after stroke using standardized patient-reported outcome measures and questions about health care utilization. Demographic and medical data were acquired from hospital records. Patients were matched on stroke severity, age, race, and gender. Matching was done with 1:2 ratio of tPA to controls. Results were compared between groups with 1-tailed tests because of a directionally specific hypothesis in favor of the tPA group. The tPA (n = 78) and control (n = 156) groups were matched across variables, except for stroke severity, which was better in the control group; subsequent analyses controlled for this mismatch. The tPA group reported better physical function, communication, cognitive ability, depressive symptomatology, and quality of life/participation compared with the control group. Fewer people in the tPA group reported skilled nursing facility stays, emergency department visits, and rehospitalizations after their stroke compared with controls. Reports of other postacute services were not different between groups. Although it is known that tPA reduces disability, this is the first study to demonstrate the effectiveness of tPA in improving meaningful, patient-reported outcomes. Thus, use of tPA provides a large benefit to the daily lives of people with ischemic stroke.
authors.affiliation: Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: langc@wustl.edu.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Lang
authors.affiliation: Program in Physical Therapy, Program in Occupational Therapy; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Marghuretta D
authors.initials: MD
authors.lastname: Bland
authors.affiliation: Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Nuo
authors.initials: N
authors.lastname: Cheng
authors.affiliation: Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Corbetta
authors.affiliation: Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Jin-Moo
authors.initials: JM
authors.lastname: Lee
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D004185:Disability Evaluation; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010359:Patient Readmission; D017064:Process Assessment, Health Care; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; comparative effectiveness; function; health care utilization; patient-reported outcomes; tPA; tissue plasminogen activator