title: Care Trajectories of Veterans in the 12 Months After Hospitalization for Acute Ischemic Stroke.
abstract: BACKGROUND
  Recovery after a stroke varies greatly between individuals and is reflected by wide variation in the use of institutional and home care services. This study sought to classify veterans according to their care trajectories in the 12 months after hospitalization for ischemic stroke.
  
  
  RESULTS
  The sample consisted of 3811 veterans hospitalized for ischemic stroke in Veterans Health Administration facilities in 2007. Three outcomes--nursing home care, home care, and mortality--were modeled jointly >12 months using latent class growth analysis. Data on Veterans' care use and cost came from the Veterans Administration and Medicare. Covariates included stroke severity (National Institutes of Health Stroke Scale), functional status (functional independence measure score), age, marital status, chronic conditions, and prestroke ambulation. Five care trajectories were identified: 49% of Veterans had Rapid Recovery with little or no use of care; 15% had a Steady Recovery with initially high nursing home or home care that tapered off; 9% had Long-Term Home Care; 13% had Long-Term Nursing Home Care; and 14% had an Unstable trajectory with multiple transitions between long-term and acute care settings. Care use was greatest for individuals with more severe strokes, lower functioning at hospital discharge, and older age. Average annual costs were highest for individuals with the Long-Term Nursing Home trajectory ($63,082), closely followed by individuals with the Unstable trajectory ($58,720). Individual with the Rapid Recovery trajectory had the lowest costs ($9271).
  
  
  CONCLUSIONS
  Care trajectories after stroke were associated with stroke severity and functional dependency and they had a dramatic impact on subsequent costs.
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.). garling@purdue.edu.
authors.forename: Greg
authors.initials: G
authors.lastname: Arling
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Susan
authors.initials: S
authors.lastname: Ofner
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Joanne K
authors.initials: JK
authors.lastname: Daggy
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Michael S
authors.initials: MS
authors.lastname: Phipps
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Neale
authors.initials: N
authors.lastname: Chumbler
authors.affiliation: From the Stroke Quality Enhancement Research Initiative (G.A., L.J.M., L.S.W., D.M.B.) and Center for Health Information and Communication (L.J.M., J.K.D., D.M.B.), Roudebush Veterans Affairs Medical Center, Indianapolis, IN; School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, IN (G.A.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Biostatistics (S.O., J.K.D), Department of Neurology (L.S.W.), and Department of Internal Medicine and Geriatrics (D.M.B., L.J.M.), Indiana University School of Medicine; Regenstrief Institute (L.S.W., D.M.B.), Indianapolis, IN; Department of Neurology, University of Maryland School of Medicine, Baltimore, and Baltimore VA Medical Center (M.S.P.); and College of Health and Human Services, Western Kentucky University, Bowling Green (N.C.).
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008134:Long-Term Care / Q000191:economics; D008297:Male; D009735:Nursing Homes / Q000191:economics; D012307:Risk Factors; D020521:Stroke / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics; D014728:Veterans / Q000706:statistics & numerical data*
keywords: cost; hospitalization; medicare; nursing homes; stroke