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J Am Geriatr Soc. 2008 Jun;56(6):999-1005. doi: 10.1111/j.1532-5415.2008.01693.x. Epub 2008 Apr 18.

The price of bouncing back: one-year mortality and payments for acute stroke patients with 30-day bounce-backs.

Author information

  • 1Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA. 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.

PMID:
18422948
[PubMed - indexed for MEDLINE]
PMCID:
PMC2736069
Free PMC Article
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