The Price of Bouncing Back: One-Year Mortality and Payments for Acute Stroke Patients with 30-Day Bounce-Backs

Authors

  • Amy J. H. Kind MD,

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author
  • Maureen A. Smith MD, MPH, PHD,

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author
  • Jinn-Ing Liou MS, MBA,

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author
  • Nancy Pandhi MD, MPH,

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author
  • Jennifer R. Frytak PHD,

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author
  • Michael D. Finch PHD

    1. From the Departments of *Population Health Sciences, Medicine, Geriatrics Section, §Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinWilliam S. Middleton Hospital, Department of Veterans Affairs, Geriatric Research Education and Clinical Center, Madison, Wisconsini3 Innovus, Eden Prairie, Minnesota#Center for Health Care Policy and Evaluation, Eden Prairie, Minnesota.
    Search for more papers by this author

  • This research was presented at the 59th Annual Scientific Meeting of the Gerontological Society of America, November 16–20, 2006, Dallas, Texas.

Address correspondence to Dr. Amy J. H. Kind, William S. Middleton VA Hospital–GRECC, 2500 Overlook Terrace, Madison, WI 53705. E-mail: ajk@medicine.wisc.edu

Abstract

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.

Ancillary