This research was presented at the 59th Annual Scientific Meeting of the Gerontological Society of America, November 16–20, 2006, Dallas, Texas.
The Price of Bouncing Back: One-Year Mortality and Payments for Acute Stroke Patients with 30-Day Bounce-Backs
Article first published online: 18 APR 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 6, pages 999–1005, June 2008
How to Cite
Kind, A. J. H., Smith, M. A., Liou, J.-I., Pandhi, N., Frytak, J. R. and Finch, M. D. (2008), The Price of Bouncing Back: One-Year Mortality and Payments for Acute Stroke Patients with 30-Day Bounce-Backs. Journal of the American Geriatrics Society, 56: 999–1005. doi: 10.1111/j.1532-5415.2008.01693.x
- Issue published online: 18 APR 2008
- Article first published online: 18 APR 2008
- patient discharge;
- health insurance reimbursement;
- patient readmission
OBJECTIVES: To examine 1-year mortality and healthcare payments of stroke patients experiencing zero, one and two or more bounce-backs within 30 days of discharge.
DESIGN: Retrospective analysis of administrative data.
SETTING: Four hundred twenty-two hospitals in the southern and eastern United States.
PARTICIPANTS: Eleven thousand seven hundred twenty-nine Medicare beneficiaries aged 65 and older surviving at least 30 days with acute ischemic stroke in 2000.
MEASUREMENTS: One-year mortality and predicted total healthcare payments were calculated using log-normal parametric survival analysis and quantile regression, respectively. Models included sociodemographics, prior medical history, stroke severity, length of stay, and discharge site.
RESULTS: Crude survival at 1 year for the zero, one and two or more bounce-back groups was 83%, 67%, and 55%, respectively. The one bounce-back group had 49% shorter (time ratio (TR)=0.51, 95% confidence interval (CI)=0.46–0.56) and the two or more bounce-backs group had 68% shorter (TR=0.32, 95% CI=0.27–0.38) adjusted 1-year survival time than the zero bounce-back group. For high- and low-cost patients, adjusted predicted payments were greater with each additional bounce-back experienced.
CONCLUSION: Acute stroke patients experiencing bounce-backs within 30 days have strikingly poorer survival and higher healthcare payments over the subsequent year than their counterparts with no bounce-backs. Bounce-backs may serve as a simple predictor for identifying stroke patients at extremely high risk for poor outcomes.