Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial

Tatjana Rundek, Kirsten Nielsen, Stephen Phillips, Karen C. Johnston, Marg Hux, David Watson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Purpose-To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse. Methods-The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100). Results-One thousand six hundred four patients who were independent before stroke (mean age: 69.9±12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US). Conclusion-Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.

Original languageEnglish
Pages (from-to)1368-1374
Number of pages7
JournalStroke
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

Fingerprint

Health Resources
Glycine
Stroke
Delivery of Health Care
Rehabilitation
Canada
Intensive Care Units
Survival
Length of Stay
Critical Care
Proportional Hazards Models
Health Care Costs
Neuroprotection
Patient Care
Hospitalization
Outpatients
Survival Rate
Logistic Models
Physicians
Costs and Cost Analysis

Keywords

  • Economics, medical
  • Health resources/utilization
  • Outcome
  • Stroke outcome
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial. / Rundek, Tatjana; Nielsen, Kirsten; Phillips, Stephen; Johnston, Karen C.; Hux, Marg; Watson, David.

In: Stroke, Vol. 35, No. 6, 01.06.2004, p. 1368-1374.

Research output: Contribution to journalArticle

Rundek, Tatjana ; Nielsen, Kirsten ; Phillips, Stephen ; Johnston, Karen C. ; Hux, Marg ; Watson, David. / Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial. In: Stroke. 2004 ; Vol. 35, No. 6. pp. 1368-1374.
@article{d58ec98eb29741d1b4c63f593de94169,
title = "Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial",
abstract = "Background and Purpose-To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse. Methods-The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100). Results-One thousand six hundred four patients who were independent before stroke (mean age: 69.9±12.7 years, 53{\%} men, 85{\%} ischemic stroke, 69{\%} in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80{\%} in both countries. Favorable functional outcome was achieved in 43{\%} of Canadian and 47{\%} of US patients. Fewer Canadian patients received treatment in ICU (19{\%} versus 63{\%} in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US). Conclusion-Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.",
keywords = "Economics, medical, Health resources/utilization, Outcome, Stroke outcome, Survival",
author = "Tatjana Rundek and Kirsten Nielsen and Stephen Phillips and Johnston, {Karen C.} and Marg Hux and David Watson",
year = "2004",
month = "6",
day = "1",
doi = "10.1161/01.STR.0000127084.26321.7a",
language = "English",
volume = "35",
pages = "1368--1374",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Health care resource use after acute stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas trial

AU - Rundek, Tatjana

AU - Nielsen, Kirsten

AU - Phillips, Stephen

AU - Johnston, Karen C.

AU - Hux, Marg

AU - Watson, David

PY - 2004/6/1

Y1 - 2004/6/1

N2 - Background and Purpose-To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse. Methods-The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100). Results-One thousand six hundred four patients who were independent before stroke (mean age: 69.9±12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US). Conclusion-Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.

AB - Background and Purpose-To compare 3-month stroke outcomes and stroke-related health care resource use between the US and Canada in the Glycine Antagonist in Neuroprotection (GAIN) Americas study. Delivery of medical care for stroke patients, often driven by efforts to curb costs, varies substantially between countries. Data on the potential impact of these variations on clinical outcomes are sparse. Methods-The analysis of health care resource included total length of stay (LOS) in hospital, intensive care unit (ICU), and acute-care ward or rehabilitation unit, or both; number of outpatient rehabilitation sessions and visits to a physician; place of residence after discharge; and employment status. Cox proportional hazards models and logistic regression were used to calculate survival hazards and predictors of favorable functional outcome (Barthel Index of 95 to 100). Results-One thousand six hundred four patients who were independent before stroke (mean age: 69.9±12.7 years, 53% men, 85% ischemic stroke, 69% in the US) were included. Three-month survival and functional outcome did not differ between the US and Canada. Survival rate was 80% in both countries. Favorable functional outcome was achieved in 43% of Canadian and 47% of US patients. Fewer Canadian patients received treatment in ICU (19% versus 63% in the US), and Canadians had longer stays in hospital or rehabilitation facility (median: 33 days versus 16 days in the US). Conclusion-Despite similar 3-month survival and functional outcome, patterns of health care resource varied substantially between the US and Canada. US patients had more intensive early care; Canadian patients had longer hospitalizations and rehabilitation care. Further research is required to determine the most cost-effective treatment and rehabilitation plan for people who have a stroke.

KW - Economics, medical

KW - Health resources/utilization

KW - Outcome

KW - Stroke outcome

KW - Survival

UR - http://www.scopus.com/inward/record.url?scp=2542610856&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=2542610856&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000127084.26321.7a

DO - 10.1161/01.STR.0000127084.26321.7a

M3 - Article

C2 - 15118182

AN - SCOPUS:2542610856

VL - 35

SP - 1368

EP - 1374

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -