title: Hospital Variation in Functional Recovery After Stroke.
abstract: Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes.
  
  
  
  Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3-6). Secondary outcomes included functional dependence (mRS score of 3-5), disabled (mRS score of 2-5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%-67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54-0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53-0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses.
  
  
  
  One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.). janet.bettger@duke.edu.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Li
authors.initials: L
authors.lastname: Liang
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Bushnell
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D054625:Healthcare Disparities / Q000592:standards / Q000639:trends*; D006761:Hospitals / Q000592:standards / Q000639:trends*; D006784:Hospitals, Teaching / Q000639:trends; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010351:Patient Discharge / Q000639:trends; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000592:standards / Q000639:trends*; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: health services research; risk adjustment; stroke; survivors