title: How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?
abstract: OBJECTIVE
  To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.
  
  
  METHODS
  A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.
  
  
  RESULTS
  Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥ 90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067-2.042) as compared with <30 minutes.
  
  
  CONCLUSIONS
  Even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with in-hospital mortality.
authors.affiliation: *VA HSR&D Center of Innovation on Disability and Rehabilitation Research, North Florida/South Georgia Veterans Health System †Department of Health Outcomes and Policy, University of Florida, Gainesville, FL ‡Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA §Veterans Affairs Medical Center ∥Physical Medicine and Rehabilitation, Albany Medical College, Albany, NY.
authors.forename: Diane C Cowper
authors.initials: DC
authors.lastname: Ripley
authors.forename: Pui L
authors.initials: PL
authors.lastname: Kwong
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.forename: Claire
authors.initials: C
authors.lastname: Davenport
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*