Primary Stroke Center Hospitalization for Elderly Patients With Stroke

Bekelis, Kimon; Marth, Nancy; Wong, Kendrew; Zhou, Weiping; Birkmeyer, John D.; Skinner, Jonathan

doi:10.1001/jamainternmed.2016.3919

Cited by 36 publications

(37 citation statements)

References 29 publications

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“…Therefore, we also calculated straight-line distance to model helicopter flight distance. We found that results were comparable to driving time (see online supplementary appendices [14][15][16][17][18][19][20][21].…”

Section: Strengthssupporting

confidence: 60%

“…12 Hospital type (eg, academic hospital, primary stroke centre) and hospital volume of treated patients with stroke as well as the travel time were associated in several studies with risk of dying from a stroke. [13][14][15] The windows for reperfusion therapy in patients with AMI and stroke indicate prompt notification of the EMS and rapid transportation to the nearest hospital with the appropriate treatment facilities. Geographical inequalities in the provision of healthcare have been shown to influence the likelihood of dying from AMI or stroke.…”

Section: Introductionmentioning

confidence: 99%

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Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study

et al. 2016

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ObjectiveSwitzerland has mountains and valleys complicating the access to a hospital and critical care in case of emergencies. Treatment success for acute myocardial infarction (AMI) or stroke depends on timely treatment. We examined the relationship between distance to different hospital types and mortality from AMI or stroke in the Swiss National Cohort (SNC) Study.Design and settingThe SNC is a longitudinal mortality study of the census 2000 population of Switzerland. For 4.5 million Swiss residents not living in a nursing home and older than 30 years in the year 2000, we calculated driving time and straight-line distance from their home to the nearest acute, acute with emergency room, central and university hospital (in total 173 hospitals). On the basis of quintiles, we used multivariable Cox proportional hazard models to estimate HRs of AMI and stroke mortality for driving time distance groups compared to the closest distance group.ResultsOver 8 years, 19 301 AMI and 21 931 stroke deaths occurred. Mean driving time to the nearest acute hospital was 6.5 min (29.7 min to a university hospital). For AMI mortality, driving time to a university hospital showed the strongest association among the four types of hospitals with a hazard ratio (HR) of 1.19 (95% CI 1.10 to 1.30) and 1.10 (95% CI 1.01 to 1.20) for men and women aged 65+ years when comparing the highest quintile with the lowest quintile of driving time. For stroke mortality, the association with university hospital driving time was less pronounced than for AMI mortality and did not show a clear incremental pattern with increasing driving time. There was no association with driving time to the nearest hospital.ConclusionsThe increasing AMI mortality with increasing driving time to the nearest university hospital but not to any nearest hospital reflects a complex interplay of many factors along the care pathway.

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Section: Strengthssupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study

et al. 2016

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“…Previous studies have used this technique to compare the performance of different institutions. Bekelis et al 6 demonstrated that Primary Stroke Centers (PSC) offer a survival benefit for stroke patients, using the differential distance to a PSC as an instrument. Propensity score stratification was also used to adjust our regressions for known confounders, whereas the possibility of clustering was accounted for by using mixed effects methods.…”

Section: Discussionmentioning

confidence: 99%

Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis

et al. 2018

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Background The interpretation of the results of prior studies on the association of hospital teaching status with surgical outcomes is limited by selection bias. We investigated whether undergoing surgical operations in teaching hospitals is associated with improved outcomes. Methods We performed a cohort study of all patients undergoing spine and cranial operations who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009-2013. We examined the association of teaching status (defined as academic affiliation for the primary analysis) with inpatient case-fatality, discharge to a facility, and length of stay (LOS). An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. Results During the study period, 186,483 patients underwent surgical operations that met the inclusion criteria. Instrumental variable analysis demonstrated that hospitalization in teaching hospitals was associated with higher rates of case-fatality (Adjusted difference, 25%; 95% CI, 4% to 46%), discharge to a facility (Adjusted difference, 5.7%; 95% CI, 4.5% to 7.0%), and longer LOS (Adjusted difference, 31.4%; 95% CI, 16.0% to 46.1%) in comparison to non-teaching hospitals. The same associations were present in propensity score adjusted mixed effects models. These persisted in pre-specified subgroups stratified on particular operations and for different definitions of teaching hospitals. Conclusions Using a comprehensive all-payer cohort of surgical patients in New York State we identified an association of treatment in teaching hospitals with increased case-fatality, rate of discharge to rehabilitation and longer LOS. Further research into the factors contributing to superior outcomes in non-teaching institutions is warranted.

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“…This was calculated based on real road network data, based on previously published methodology. (14) This advanced observational technique has been used before by clinical researchers, to answer comparative effectiveness questions for different interventions, including the value of primary stroke centers. The goal is to simulate randomization, especially when the baseline functional characteristics of the patients (including the functional status of stroke patients) are unknown (similar to our application).…”

Section: Methodsmentioning

confidence: 99%

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

Bekelis

Missios

MacKenzie

2018

British Journal of Neurosurgery

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Purpose The quality of physicians practicing in hospitals recognized for nursing excellence by the American Nurses Credentialing Center has not been studied before. We investigated whether Magnet hospital recognition is associated with higher quality of physicians performing neurosurgical procedures. Materials and Methods We performed a cohort study of patients undergoing neurosurgical procedures from 2009–2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. Propensity score adjusted multivariable regression models were used to adjust for known confounders, with mixed effects methods to control for clustering at the facility level. An instrumental variable analysis was used to control for unmeasured confounding and simulate the effect of a randomized trial. Results During the study period, 185,277 patients underwent neurosurgical procedures, and met the inclusion criteria. Of these, 66,607 (35.6%) were hospitalized in Magnet hospitals, and 118,670 (64.4%) in non-Magnet institutions. Instrumental variable analysis demonstrated that undergoing neurosurgical operations in Magnet hospitals was associated with a 13.6% higher chance of being treated by a physician with superior performance in terms of mortality (95% CI, 13.2% to 14.1%), and a 4.3% higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (95% CI, 3.8% to 4.7%) in comparison to non-Magnet institutions. The same associations were present in propensity score adjusted mixed effects models. Conclusions Using a comprehensive all-payer cohort of neurosurgical patients in New York State we identified an association of Magnet hospital recognition with superior physician performance.

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Primary Stroke Center Hospitalization for Elderly Patients With Stroke

Cited by 36 publications

References 29 publications

Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study

Do acute myocardial infarction and stroke mortality vary by distance to hospitals in Switzerland? Results from the Swiss National Cohort Study

Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis

Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State

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