Stroke survivors benefit from spending time at home

A recent study found there was significant variation in home-time among hospitals and certain characteristics in patients and hospitals determine how much time patients spend at home without further issues.

Still, that metric, known as home-time, is not often tracked. A recent study found there was significant variation in home-time among hospitals. The research also found certain patient and hospital characteristics determine how much time patients spend at home without further issues. The results were published in Stroke on Sept. 13.

A couple of finding stood out. Hospitals with the higher home-time had lower rates of major adverse cardiovascular events and all-cause mortality. And patients are determined to be in their homes.

“Examining outcomes that matter to patients is increasingly recognized as an essential component of patient-centered comparative effectiveness research,” the researchers wrote. “Prior work suggests that home-time is a highly prioritized outcome for patients.”

The study examined 156,887 patients from the Get With The Guidelines-Stroke (GWTG-Stroke) registry who survived an ischemic stroke, were at least 65 years old and were enrolled in fee-for-service Medicare.  The median unadjusted hospital mean home-time was 59.5 days during the first 90 days and 270.2 days during the first year.

Patients discharged from hospitals with lower home-times were more likely to be older, a woman and black. They also had higher rates of stroke, atrial fibrillation, heart failure, diabetes and hypertension.

After case-mix adjustment, the researchers found that hospitals with higher 90-day and one-year home-times tended to have higher annual ischemic stroke volume and be located in a rural setting and be smaller than hospitals with lower home-times.

The Centers for Medicare and Medicaid Services (CMS) has expressed interest in tying hospitals’ reimbursement to risk-adjusted stroke hospitalization rates, according to the researchers. This data may be useful for hospitals to understand the importance of home-time to patients and to short- and long-term outcomes, although the study had a few limitations. For instance, it only included Medicare beneficiaries and did not account for time spent in private nursing homes and other facilities that CMS does not reimburse.

The researchers also acknowledged that home-time could be influenced by patient’s access to inpatient rehabilitation and skilled nursing facilities, whether they can afford poststroke services and whether community resources are available Socioeconomic status, marital status and existence of a social support system also might play a role in how much time patients spend at home following a stroke.

“Given that longer-term outcomes may be more meaningful to patients, we created a longer-term representation of home-time during the year post discharge,” the researchers wrote. “Additional studies are needed to elucidate the processes of care and resources (for example, availability of inpatient rehabilitation facilities in rural locations) that may contribute to variation in postdischarge home-time.”