How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke

Bibliographic Data

ID9104581
AuthorsDiane C Cowper Ripley, Diane Cowper Ripley (North Florida/South Georgia Veterans Health System, corresponding author), Pui L Kwong (University of Pennsylvania), W Bruce Vogel, Bruce Vogel (0000-0002-8491-826X, University of Florida Health, corresponding author), Jibby E Kurichi (0000-0001-8694-355X, University of Pennsylvania), Barbara Bates (Veterans Health Administration), Barbara E Bates, Claire Davenport (Veterans Health Administration)
Year2015
Volume53
Issue6
Pages501-509
Publication date2015-06-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000366
PMID25961660
OpenAlexW279606957
LanguageEN
Citations received4
References cited2

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

Confounding · Environmental health · Logistic regression · Observational study · Odds · Odds ratio · Population · Stroke (engine) · Acute Ischemic Stroke Management · Emergency Medicine · Hospital Admissions and Outcomes · Internal Medicine · Medicine · Trauma and Emergency Care Studies