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The Impact of Transferring Stroke Patients: An Analysis of National Administrative Data

  • Charlotte Zerna (a1), Noreen Kamal (a1), M. Patrice Lindsay (a2), Jiming Fang (a3) and Michael D. Hill (a4)...

Abstract

Background: Interhospital transfer is an important but resource-intensive pattern of care. The use for stroke patients is highly dependent upon health system structure. We examined the impact of hospital transfers for stroke care in Canada. Methods: We analyzed hospital administrative data within the Canadian Institute for Health Information (CIHI) Database for the 3 fiscal years 2011/12, 2012/13 and 2013/14. Patients with clinical stroke syndrome (ischemic or hemorrhagic) were identified using International Classification of Diseases. Stroke centers were defined by Heart & Stroke Foundation of Canada stroke report. Results: During the 3-year period,397 patients in Canada (excluding Quebec) were admitted to hospital for clinical stroke syndrome. Median age was 75 (interquartile range [IQR] 64–84) years; 50.6 % were male. Less than 5% (n=4030) of patients were transferred. Patients transferred to stroke centers were younger (p<0.001) and had shorter median length of stay (p<0.001). The highest probability of discharge home was associated with sole care at stroke center (43.8%). Transfer to stroke center from community hospital had the highest probability for discharge to rehabilitation facility (25%) and lowest to either long-term (2.1%) or complex community care (2.0%). Transferred patients had lower mortality at discharge. Conclusion: Younger patients were transferred more frequently to stroke centers; older patients were more likely treated in community hospitals. Sole stroke center care was associated with high discharge rate to home; transfer to a stroke center was associated with high discharge rate to rehabilitation and lower mortality rates.

L’impact du transfert de patients victimes d’un accident vasculaire cérébral : une analyse de données administratives pancanadiennes. Contexte: Le transfert d’un patient vers un autre hôpital constitue une avenue thérapeutique notable qui exige néanmoins beaucoup de ressources. Dans le cas de patients victimes d’un accident vasculaire cérébral (AVC), une telle avenue demeure fortement tributaire des structures d’un système de santé. Nous voulons donc examiner l’impact des transferts hospitaliers sur les soins prodigués à des patients canadiens victimes d’un AVC. Méthodes: Nous avons analysé des données clinico-administratives récoltées par l’Institut canadien d’information sur la santé (ICIS). Ces données concernent les années budgétaires 2011-2012, 2012-2013 et 2013-2014. Des patients chez qui on avait diagnostiqué un syndrome clinique lié à un AVC, qu’il soit de nature ischémique ou hémorragique, ont été sélectionnés au moyen de la Classification statistique internationale des maladies. La notion de « centre de soins complets de l’AVC » a quant à elle été définie par la Fondation des maladies du cœur et de l’AVC dans un de ses rapports. Résultats: Durant cette période de trois ans, 397 patients du Canada (à l’exclusion du Québec) ont été hospitalisés en raison d’un syndrome clinique lié à un AVC. Leur âge moyen était de 75 ans (écart interquartile de 64 – 84) tandis que 50,6 % d’entre eux étaient de sexe masculin. Au total, moins de 5% (n = 4030) des patients ont été transférés. Ceux l’ayant été vers des centres de soins complets de l’AVC étaient plus jeunes (p < 0,001) ; la durée médiane de leur séjour était aussi plus courte (p < 0,001). La probabilité la plus élevée d’obtenir un congé pour retourner à la maison était associée aux centres de soins complets de l’AVC (43,8%). Un transfert d’un hôpital communautaire vers un centre de soins complets de l’AVC était aussi associé à une probabilité plus élevée d’obtenir un congé à destination d’un établissement de réadaptation (25%) mais aussi à une probabilité plus basse de l’être vers des soins de longue durée (2,1%) ou des soins communautaires de nature complexe (2,0%). Enfin, les patients transférés donnaient à voir un plus faible taux de mortalité à la suite d’un congé. Conclusions: Les patients moins âgés étaient transférés moins fréquemment à des centres de soins complets de l’AVC. De leur côté, les patients plus âgés étaient plus susceptibles d’être soignés dans des hôpitaux communautaires. Seuls les centres de soins complets de l’AVC étaient associés à un taux élevé de congés à destination du domicile tandis que les transferts vers des centres de soins complets de l’AVC étaient associés à un taux élevé de congés vers des services de réadaptation ainsi qu’à des taux de mortalité inférieurs.

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Copyright

Corresponding author

Correspondence to: Charlotte Zerna, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary H3300 Hospital Drive NW, Calgary, AB, T2N 4N1 CANADA. Email: Charlotte.Zerna@albertahealthservices.ca

References

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1. Niessen, LW, Barendregt, JJ, Bonneux, L, Koudstaal, PJ. Stroke trends in an aging population. The Technology Assessment Methods Project Team. Stroke: A Journal of Cerebral Circulation. 1993;24(7):931-939.
2. Börsch-Supan, A. Aging population: Problems and policy options in the US and Germany. Econ Policy. 1991:104-139.
3. Lozano, R, Naghavi, M, Foreman, K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-2128.
4. Mayo, NE, Hendlisz, J, Goldberg, MS, Korner-Bitensky, N, Becker, R, Coopersmith, H. Destinations of stroke patients discarged from the Montreal area acute-care hospitals. Stroke: A Journal of Cerebral Circulation. 1989;20(3):351-356.
5. Fonarow, GC, Reeves, MJ, Smith, EE, et al. Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke. Circulation: Cardiovascular Quality and Outcomes. 2010;3(3):291-302.
6. Canadian Institutes for Health Information. Discharge Abstracts Database Metadata. Available from: https://www.cihi.ca/en/types-of-care/hospital-care/acute-care/dad-metadata.
7. Kokotailo, RA, Hill, MD. Coding of stroke and stroke risk factors using international classification of diseases, revisions 9 and 10. Stroke: A Journal of Cerebral Circulation. 2005;36(8):1776-1781.
8. Canadian Heart and Stroke Foundation. Together against a rising tide: Advancing stroke systems of care. 2014 Stroke Report. 2014.
9. Casaubon, LK, Boulanger, JM, Blacquiere, D, et al. Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015. International Journal of Stroke: Official Journal of the International Stroke Society. 2015;10(6):924-940.
10. Bodechtel, U, Barlinn, K, Siepmann, T, et al. Telestroke care can achieve adequate onset-to-treatment time despite prolonged door-to-needle time. Journal of Stroke and Cerebrovascular Diseases. Submitted.
11. Nguyen, C, Mir, O, Vahidy, F, et al. Resource utilization for patients with intracerebral hemorrhage transferred to a comprehensive stroke center. Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association. 2015;24(12):2866-2874.
12. European Stroke Organisation. Consensus statement on mechanical thrombectomy in acute ischemic stroke. ESO-Karolinska Stroke Update. 2014.
13. Mocco, J, Fargen, KM, Goyal, M, et al. Neurothrombectomy trial results: stroke systems, not just devices, make the difference. Int J Stroke. 2015;10(7):990-993.
14. Fuentes, B, Alonso de Lecinana, M, Ximenez-Carrillo, A, et al. Futile interhospital transfer for endovascular treatment in acute ischemic stroke: the Madrid Stroke Network experience. Stroke: A Journal of Cerebral Circulation. 2015;46(8):2156-2161.
15. Hill, MD, Goyal, M, Demchuk, AM. Endovascular stroke therapy--a new era. International Journal of Stroke: Official Journal of the International Stroke Society. 2015;10(3):278-279.
16. Gupta, R, Horev, A, Nguyen, T, et al. Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes. Journal of Neurointerventional Surgery. 2013;5(4):294-297.
17. McNeill, L, English, SW, Borg, N, Matta, BF, Menon, DK. Effects of institutional caseload of subarachnoid hemorrhage on mortality: a secondary analysis of administrative data. Stroke: A Journal of Cerebral Circulation. 2013;44(3):647-652.

The Impact of Transferring Stroke Patients: An Analysis of National Administrative Data

  • Charlotte Zerna (a1), Noreen Kamal (a1), M. Patrice Lindsay (a2), Jiming Fang (a3) and Michael D. Hill (a4)...

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