Patients’ time at home after a stroke varies by hospital

DURHAM: Stroke survivors may spend more time at home – as opposed to a nursing home or a hospital – if they were treated at a place that handles a lot of stroke patients or that’s located in a rural area, a U.S. study suggests.

Patients treated at smaller hospitals also tended to spend more days at home after a stroke, the study also found.

“Home-time after stroke varied depending on where patients were hospitalized and in what type of hospital,” said study leader Emily O’Brian of Duke University in Durham, North Carolina.

“We also found that hospitals with higher home-time had lower rates of major adverse cardiovascular events and all-cause mortality, suggesting that home time could be a marker of care quality,” O’Brian added by email.

To assess how hospital characteristics influence home-time, researchers analyzed data on 156,887 patients 65 and older who were discharged from 989 hospitals across the U.S. from 2007 to 2011.

All of the patients had what’s known as ischemic stroke, which results from an obstruction in a blood vessel supplying the brain.

Researchers sorted hospitals into four groups from lowest to highest amounts of home time, when patients avoided a repeat hospitalization or a stay in nursing home or other care facility.

Over the first three months after discharge, average home time was 62 to 73 days for patients treated at hospitals in the highest-ranked group, compared with 49 to 58 days with hospitals in the lowest quartile, researchers report in the journal Stroke.

During the first year after discharge, average home time was 274 to 302 days for hospitals in the highest-ranked group, compared with 243 to 264 days for the lowest quartile.

Overall, patients who spent the least amount of time at home in those first three months were more likely to be older, female, black, and have more medical problems in addition to stroke than people who spent the most time at home.

One limitation of the study is that researchers only had data on care covered by Medicare, the U.S. health program for the elderly, which would exclude any time patients spent in nursing homes that they paid for themselves, the authors note.

Because all of the patients in the study were at least 65, it’s also possible that the results might not apply to younger stroke survivors, the authors also point out.

One way patients can help maximize time at home after a stroke is by starting to research rehabilitation facilities as soon as possible, said Dr. Daniel Lackland, a researcher at the Medical University of South Carolina who wasn’t involved in the study.

“This is essential in order to achieve the highest level of independence and quality of life,” Lackland added by email.

Stroke is an emergency, and patients are typically rushed to the closest hospital that can treat them because faster care increases survival odds and minimizes the risk of lasting disabilities.

“Patients are often not in a position to choose their treating hospital, because their physical location more than anything usually dictates at what facility they will be cared for,” said Dr. Roland Faigle, a neurology researcher at Johns Hopkins University School of Medicine in Baltimore.

“For patients and their families, the number one goal should still be to attempt to prevent a stroke altogether, i.e. by controlling stroke risk factors, such as high blood pressure, high cholesterol, and diabetes, in addition to smoking cessation,” Faigle, who wasn’t involved in the study, said by email.

“If a stroke is occurring regardless, then the most important thing is to be aware of the signs and symptoms of a stroke, recognize stroke as an emergency, and to call 911 immediately when a stroke is suspected,” Faigle added.