How Does Geographic Access Affect In-Hospital Mortality for Veterans With Acute Ischemic Stroke?. Issue 6 (June 2015)

• Record Type: Journal Article
• Authors: Ripley, Diane C. Cowper; Kwong, Pui L.; Vogel, W. Bruce; Kurichi, Jibby E.; Bates, Barbara E.; Davenport, Claire
• Is Part Of: Medical care. Volume 53:Issue 6(2015)
• Publication Date: 2015-06
• Subjects: Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000366
• Languages: English
• ISSNs: 0025-7079

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>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.</p> </sec> <sec> <title>Methods:</title> <p>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<sup>2</sup> analyses or Student <italic>t</italic> 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.</p> </sec> <sec> <title>Results:</title> <p>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.</p> </sec> <sec> <title>Conclusions:</title> <p>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.</p> </sec> </abstract>