Abstract 3954: Does the Volume of Stroke/TIA Admissions Relate to Clinical Outcomes in the Ontario Stroke System?
Notice bibliographique
Résumé
Background: Previous research has found decreased mortality rates among hospitals that treat high volumes of patients for specific surgical and medical conditions. The degree of association between mortality and volume varies substantially by condition and procedure, and while this relationship has been examined for many surgical procedures and medical conditions, few studies have looked at stroke We examine the volume-outcome relationship among Ischemic stroke patients. Knowledge of how to guide access to care for people with stroke is of increasingly concern given expected growing costs of medical care. Methods: All ischemic stroke separations at 128 acute hospitals in the province of Ontario from 2003 to 2009 were analyzed using administrative databases. Spline plots were used to establish small, medium and high volume-based categories. Mulivariate hierarchical modeling was used to evaluate the volume outcome relationship. The outcome of interest was 30-day mortality. Results: From 2003 through 2009, 71,856 hospitalizations for stroke/TIA occurred in 128 hospitals. The mean (+/- SD) number of annual hospitalizations for stroke/TIA was 43(30) for small volume hospitals, 157(55) for medium volume hospitals and 278(73) for high volume hospitals. Patient Characteristics: Patients admitted to high volume hospitals were younger, 54% of patients are 75 years of age or older compared to 61% at small volume hospitals (p <0.0001). Patients at small volume hospitals were similar with respect to prevalence of comordid conditions with exception of hypertension, cancer, diabetes, old AMI and renal disease where patients at small volume hospitals had lower prevalence (p < 0.01). Hospital Characteristics: Approximately 15% were specialized stroke centres and 7% had the capacity to provide neurosurgical services. Large volume hospitals were more likely to be specialized stroke centres and or teaching hospitals compared to medium or small hospitals. Overall 30-day risk-adjusted ischemic stroke mortality over the seven year period was 17%. Patients cared for in low volume hospitals have a 30% higher mortality rate compared to patients cared for in a high volume hospital. There was no statistically significant difference in 30-day mortality between medium and high volume hospitals. Conclusions: Similar to procedure-based volume outcome relationships, there does appear to be an association between acute hospital stroke volume and 30-day mortality among ischemic stroke patients in Ontario. Hospitals that have average annual stroke volumes greater than 15 but less than 45 per year have 30 day mortality rates 30% higher than hospitals that see on average 278 stroke/TIA patients per year.itals. The critical threshold is about 150 patients per year. This could be explained by higher likelihood of admission to stroke units or to the expertise developed by regularly caring for stroke patients.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».