Hospital Variation in Functional Recovery After Stroke

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Functional status is a critical patient-centered outcome after stroke.
• Limited data exist on inter-hospital variability in functional recovery post-stroke.
• Understanding this variability is crucial for improving stroke care quality.

Purpose of the Study:

• To examine the distribution of functional status 3 months after stroke.
• To determine if functional outcomes vary among different hospitals.
• To identify hospital characteristics linked to better or worse functional recovery.

Main Methods:

• Analysis of 2083 ischemic stroke patients from the AVAIL study across 82 US hospitals.
• Primary outcome: dependence or death at 3 months (modified Rankin Scale [mRS] 3-6).
• Risk adjustment was performed to account for patient factors.

Main Results:

• 36.5% of patients were functionally dependent or deceased by 3 months post-discharge.
• Significant variation in dependence/death rates observed across hospitals (0%-67%).
• Teaching hospitals and certified primary stroke centers showed lower rates of dependence or death after risk adjustment.

Conclusions:

• Approximately one-third of ischemic stroke patients experience functional dependence or death 3 months post-stroke.
• Considerable hospital-level variation in functional recovery necessitates further investigation into care processes.
• Identifying and implementing best practices can potentially maximize functional outcomes for stroke survivors.