Home-Time Is a Feasible and Valid Stroke Outcome Measure in National Datasets

McDermid, Iain; Barber, Mark; Dennis, Martin; Langhorne, Peter; MacLeod, Mary Joan; McAlpine, Christine; Quinn, Terence J

doi:10.1161/strokeaha.118.023916

Cited by 31 publications

(45 citation statements)

References 12 publications

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“…with the modified Rankin Scale or the Barthel Index. [11][12][13][14][15]36,39,40 Here, we demonstrate a strong correlation with another measure of functional status, the FIM, adding weight to the construct validity of 'home-time'. Total FIM and motor subscale scores were strongly associated with 'home-time', whereas the correlation between cognitive subscale scores and days spent at home was more moderate.…”

Section: Previous Results Demonstrate That 'Home-time' Correlatesmentioning

confidence: 86%

“…In keeping with other research, 14 For patients who died or were discharged to a residential nursing home care within the 90-day follow-up period, zero days were counted from the date of death or discharge to residential care, respectively. The Admitted Patient Data Collection records patient discharges to nursing home placements if these placements represent a change in the patient's usual residence, thus, where recorded, we were able to identify patients for whom nursing home care was a new requirement after stroke.…”

Section: Calculation Of 90-day 'Home-time'mentioning

confidence: 99%

“…27 The correlation between GCS and 'home-time' attenuated when inpatient deaths were removed from the cohort consistent with patterns of correlations reported when using gold-standard stroke severity assessment. 14…”

Section: Main Findingsmentioning

confidence: 99%

“…'Home-time' measures the number of days spent at home after stroke onset, taking into account patient survival and days spent in hospital, reflecting a patient's capacity to return to their private residence after hospitalisation. [11][12][13][14][15] 'Home-time' therefore can be unobtrusively and objectively measured using routinely collected data that are linked to health records following stroke and is proposed as a patient-centred surrogate measure of functional status. 'Home-time' in stroke is often measured within 90 days of admission, [11][12][13][14][15] in keeping with the gold-standard follow-up period for clinical trials and epidemiological research.…”

mentioning

confidence: 99%

“…11 Few studies validating 'home-time' are population based or have validated 'home-time' against both severity and outcome measures and for all stroke subtypes. 11,14 Furthermore, there is limited information about prognostic indicators of 'home-time' and validation has yet to be conducted where severity, 'hometime' and functional status are measured wholly using routinely collected data.…”

mentioning

confidence: 99%

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Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

et al. 2020

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Aims Administrative data offer cost‐effective, whole‐of‐population stroke surveillance yet the lack of validated measures of functional status is a shortcoming. The number of days spent living at home after stroke (‘home‐time’) is a patient‐centred outcome that can be objectively ascertained from administrative data. Population‐based validation against both severity and outcome measures and for all subtypes is lacking. We aimed to report representative ‘home‐time’ estimates and validate ‘home‐time’ as a surrogate measure of functional status after stroke. Methods Stroke hospitalisations from a state‐wide census in New South Wales, Australia, from January 1, 2005 to March 31, 2014 were linked to prehospital data, poststroke admissions and deaths. We correlated 90‐day ‘home‐time’ with Glasgow Coma Scale (GCS) scores, measured upon a patient's initial contact with paramedics and Functional Independence Measure (FIM) scores, measured upon entry to rehabilitation after the acute hospital stroke admission. Negative binomial regressions identified predictors of ‘home‐time’. Results Patients with stroke (N = 74 501) spent a median of 53 days living at home 90 days after the event. Median ‘home‐time’ was 60 days after ischaemic stroke, 49 days after subarachnoid haemorrhage and 0 days after intracerebral haemorrhage. GCS and FIM scores significantly correlated with ‘home‐time’ (P < .001). Women spent significantly less time at home compared with men after stroke, although being married increased ‘home‐time’ after ischaemic stroke and subarachnoid haemorrhage. Conclusions These findings underscore the immediate and adverse impact of stroke. ‘Home‐time’ measured using administrative data is a robust, replicable and valid patient‐centred outcome enabling inexpensive population‐based surveillance and system‐wide quality assessment.

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Section: Previous Results Demonstrate That 'Home-time' Correlatesmentioning

confidence: 86%

Section: Calculation Of 90-day 'Home-time'mentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

et al. 2020

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Increasing home‐time after a first diagnosis of heart failure in Sweden, 20 years trends

Ekestubbe

Giang

et al. 2021

ESC Heart Failure

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Aims This study was performed to compare trends in home-time for patients with heart failure (HF) between those of working age and those of retirement age in Sweden from 1992 to 2012. Methods and resultsThe National Inpatient Register (IPR) was used to identify all patients aged 18 to 84 years with a first hospitalization for HF in Sweden from 1992 to 2012. Information on date of death, comorbidities, and sociodemographic factors were collected from the Swedish National Register on Cause of Death, the IPR, and the longitudinal integration database for health insurance and labour market studies, respectively. The patients were divided into two groups according to their age: working age (<65 years) and retirement age (≥65 years). Follow-up was 4 years. In total, following exclusions, 388 775 patients aged 18 to 84 years who were alive 1 day after discharge from a first hospitalization for HF were included in the study. The working age group comprised 62 428 (16%) patients with a median age of 58 (interquartile range, 53-62) years and 31.2% women, and the retirement age group comprised 326 347 (84%) patients with a median age of 77 (interquartile range, 73-81) years and 47.4% women. Patients of working age had more home-time than patients of retirement age (83.8% vs. 68.2%, respectively), mainly because of their lower 4 year mortality rate (14.2% vs. 29.7%, respectively). Home-time increased over the study period for both age groups, but the increase levelled off for older women after 2007, most likely because of less reduction in mortality in older women than in the other groups. Conclusions This nationwide study showed increasing home-time over the study period except for women of retirement age and older for whom the increase stalled after 2007, mainly because of a lower mortality reduction in this group. Efforts to improve patient-related outcome measures specifically targeted to this group may be warranted.

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Time spent outside of the hospital, CKD progression, and mortality: a prospective cohort study

Zhang

et al. 2021

Int Urol Nephrol

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Home-Time Is a Feasible and Valid Stroke Outcome Measure in National Datasets

Cited by 31 publications

References 12 publications

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

Measuring stroke outcomes for 74 501 patients using linked administrative data: System‐wide estimates and validation of ‘home‐time’ as a surrogate measure of functional status

Increasing home‐time after a first diagnosis of heart failure in Sweden, 20 years trends

Time spent outside of the hospital, CKD progression, and mortality: a prospective cohort study

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