Healthcare Utilization for Stroke Patients at the End of Life: Nationally Representative Data.
J Stroke Cerebrovasc Dis
; 30(10): 106008, 2021 Oct.
Article
in En
| MEDLINE
| ID: mdl-34330019
ABSTRACT
Objectives Stroke and post-stroke complications are associated with high morbidity, mortality, and cost. Our objective was to examine healthcare utilization and hospice enrollment for stroke patients at the end of life. Materials and methods The 2014 Nationwide Readmissions Database is a national database of > 14 million admissions. We used validated ICD-9 codes to identify fatal ischemic stroke, summarized demographics and hospitalization characteristics, and examined healthcare use within 30 days before fatal stroke admission. We used de-identified 2014 Medicare hospice data to identify stroke and non-stroke patients admitted to hospice. Results Among IS admissions in 2014 (n = 472,969), 22652 (4.8%) had in-hospital death. 28.2% with fatal IS had two or more hospitalizations in 2014. Among those with fatal IS admission, 13.0% were admitted with cerebrovascular disease within 30 days of fatal IS admission. Half of stroke patients discharged to hospice from the Medicare dataset were hospitalized with cerebrovascular disease within the thirty days prior to hospice enrollment. Within the study year, 6.9% of hospice enrollees had one or more emergency room visits, 31.7% had one or more inpatient encounters, and 5.2% had one or more nursing facility encounters (compared to 21.4%, 70.6%, and 27.2% respectively in the 30-day period prior to enrollment). Conclusions High rates of readmission prior to fatal stroke may indicate opportunity for improvement in acute stroke management, secondary prevention, and palliative care involvement as encouraged by AHA/ASA guidelines. For patients who are expected to survive 6 months or less, hospice may offer goal-concordant services for patients and caregivers who desire comfort-focused care.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Palliative Care
/
Terminal Care
/
Hospice Care
/
Ischemic Stroke
/
Health Resources
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Implementation_research
Limits:
Aged
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
J Stroke Cerebrovasc Dis
Journal subject:
ANGIOLOGIA
/
CEREBRO
Year:
2021
Document type:
Article