title: Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries.
abstract: OBJECTIVE
  Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event.
  
  
  METHODS
  Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index.
  
  
  RESULTS
  There were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70-82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2-7]) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52-86) days and 349 (IQR, 303-360) days and median mRS were 2 (IQR, 1-4) and 2 (IQR, 1-4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient, -0.731; P<0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 (c-index, 0.837). Similar findings were observed at 1 year.
  
  
  CONCLUSIONS
  In a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.). gfonarow@mednet.ucla.edu.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Emily C
authors.initials: EC
authors.lastname: O'Brien
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bushnell
authors.affiliation: From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.).
authors.forename: Janet
authors.initials: J
authors.lastname: Prvu Bettger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006699:Home Care Services / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000639:trends*; D010351:Patient Discharge / Q000639:trends; D018802:Patient-Centered Care / Q000639:trends*; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: modified Rankin Scale; patient-centered outcomes research; skilled nursing facilities; stroke; survivors