How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?
OBJECTIVE:To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures. METHODS:A longitudinal ob...
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| Veröffentlicht in: | Medical care 2015-06, Vol.53 (6), p.501-509 |
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| creator | Ripley, Diane C. Cowper Kwong, Pui L. Vogel, W. Bruce Kurichi, Jibby E. Bates, Barbara E. Davenport, Claire |
| description | OBJECTIVE:To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.
METHODS:A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.
RESULTS:Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067–2.042) as compared with |
| doi_str_mv | 10.1097/MLR.0000000000000366 |
| format | Article |
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METHODS:A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.
RESULTS:Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067–2.042) as compared with <30 minutes.
CONCLUSIONS:Even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with in-hospital mortality.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/MLR.0000000000000366</identifier><identifier>PMID: 25961660</identifier><identifier>CODEN: MELAAD</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Comorbidity ; Correlation analysis ; Demographics ; Female ; Health Services Accessibility - statistics & numerical data ; Hospital Mortality ; Humans ; Longitudinal Studies ; Male ; Medical treatment ; Middle Aged ; Mortality ; Original Article ; Residence Characteristics ; Risk Factors ; Stroke - mortality ; Time Factors ; United States ; United States Department of Veterans Affairs ; Veterans ; Veterans - statistics & numerical data</subject><ispartof>Medical care, 2015-06, Vol.53 (6), p.501-509</ispartof><rights>Copyright © 2015 Wolters Kluwer Health, Inc.</rights><rights>Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.</rights><rights>Copyright Lippincott Williams & Wilkins Jun 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4066-b000eabc14a15c2a5b1751a96de3f2cdebb20471164b597acde747740174b6063</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/26417997$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/26417997$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,27923,27924,58016,58249</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25961660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ripley, Diane C. Cowper</creatorcontrib><creatorcontrib>Kwong, Pui L.</creatorcontrib><creatorcontrib>Vogel, W. Bruce</creatorcontrib><creatorcontrib>Kurichi, Jibby E.</creatorcontrib><creatorcontrib>Bates, Barbara E.</creatorcontrib><creatorcontrib>Davenport, Claire</creatorcontrib><title>How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?</title><title>Medical care</title><addtitle>Med Care</addtitle><description>OBJECTIVE:To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.
METHODS:A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.
RESULTS:Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067–2.042) as compared with <30 minutes.
CONCLUSIONS:Even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with in-hospital mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Comorbidity</subject><subject>Correlation analysis</subject><subject>Demographics</subject><subject>Female</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Article</subject><subject>Residence Characteristics</subject><subject>Risk Factors</subject><subject>Stroke - mortality</subject><subject>Time Factors</subject><subject>United States</subject><subject>United States Department of Veterans Affairs</subject><subject>Veterans</subject><subject>Veterans - statistics & numerical data</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUlPwzAQhS0EgrL8A0CWuHAJeIvdnFDF1kqtkFiPwXEnJCWti-2o4t9j1LKIC3MZafS9p5l5CO1TckJJpk5Hw9sT8ru4lGuoQ1OuEpqJ7jrqEMLSRBGVbaFt7yeEUMVTtom2WJpJKiXpoOe-XeALCx5fg31xel7VBveMAe9xryzBBDyYJX3r53XQDR5ZF1sd3nFpHX6EAE7PPH6qQxVVbQA88KaCaTS5C86-wtku2ih142Fv1XfQw9Xl_Xk_Gd5cD857w8QIImVSxANAF4YKTVPDdFpQlVKdyTHwkpkxFAUjQlEqRZFmSseJEkqJeJIoJJF8Bx0vfefOvrXgQz6tvYGm0TOwrc-p7FImOVciokd_0Ilt3Sxu90lxSQRjKlJiSRlnvXdQ5nNXT7V7zynJPxPIYwL53wSi7HBl3hZTGH-Lvl4ege4SWNgmvs-_Nu0CXF6BbkL1n_fBUjrxwbofaymoyjLFPwCvNZnj</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Ripley, Diane C. Cowper</creator><creator>Kwong, Pui L.</creator><creator>Vogel, W. Bruce</creator><creator>Kurichi, Jibby E.</creator><creator>Bates, Barbara E.</creator><creator>Davenport, Claire</creator><general>Lippincott Williams & Wilkins</general><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201506</creationdate><title>How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?</title><author>Ripley, Diane C. Cowper ; Kwong, Pui L. ; Vogel, W. Bruce ; Kurichi, Jibby E. ; Bates, Barbara E. ; Davenport, Claire</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4066-b000eabc14a15c2a5b1751a96de3f2cdebb20471164b597acde747740174b6063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Comorbidity</topic><topic>Correlation analysis</topic><topic>Demographics</topic><topic>Female</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Article</topic><topic>Residence Characteristics</topic><topic>Risk Factors</topic><topic>Stroke - mortality</topic><topic>Time Factors</topic><topic>United States</topic><topic>United States Department of Veterans Affairs</topic><topic>Veterans</topic><topic>Veterans - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ripley, Diane C. Cowper</creatorcontrib><creatorcontrib>Kwong, Pui L.</creatorcontrib><creatorcontrib>Vogel, W. Bruce</creatorcontrib><creatorcontrib>Kurichi, Jibby E.</creatorcontrib><creatorcontrib>Bates, Barbara E.</creatorcontrib><creatorcontrib>Davenport, Claire</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ripley, Diane C. Cowper</au><au>Kwong, Pui L.</au><au>Vogel, W. Bruce</au><au>Kurichi, Jibby E.</au><au>Bates, Barbara E.</au><au>Davenport, Claire</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2015-06</date><risdate>2015</risdate><volume>53</volume><issue>6</issue><spage>501</spage><epage>509</epage><pages>501-509</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><coden>MELAAD</coden><abstract>OBJECTIVE:To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemic stroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.
METHODS:A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.
RESULTS:Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067–2.042) as compared with <30 minutes.
CONCLUSIONS:Even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with in-hospital mortality.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>25961660</pmid><doi>10.1097/MLR.0000000000000366</doi><tpages>9</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Comorbidity Correlation analysis Demographics Female Health Services Accessibility - statistics & numerical data Hospital Mortality Humans Longitudinal Studies Male Medical treatment Middle Aged Mortality Original Article Residence Characteristics Risk Factors Stroke - mortality Time Factors United States United States Department of Veterans Affairs Veterans Veterans - statistics & numerical data |
| title | How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke? |
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