Abstract TMP70: Assessment of Home Time Following Acute Ischemic Stroke in Medicare Beneficiaries
Bibliographic record
Abstract
Background: Stroke survivors have identified “home-time” (days spent at home alive and outside of a hospital) as a meaningful outcome. However, home-time has not been well studied as an outcome of interest outside of clinical trials. We aimed to evaluate home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Score (mRS) at 90 days and 1 year post event. Methods: Patients ≥65 years old enrolled in GWTG-Stroke and AVAIL (Adherence eValuation After Ischemic Stroke Longitudinal) registry were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital or skilled nursing facility, at 90 days and 1 year after admission for ischemic stroke. The correlation of home-time with mRS at 90 days and 1 year from admission were evaluated graphically and by Pearson correlation coefficients. In addition, to assess the level of agreement between measures, the c-index of 90 day and 1 year home-time predicting 90 day and 1 year mRS 0-2 were determined. Results: There were 815 ischemic stroke patients (age median 76 years [IQR 70-82], 46% female, NIHSS median 4 [IQR 2-7]) from 88 participating hospitals. The 90 day and 1 year median home-times were 79 days (IQR 52-86) and 349 days (IQR 303-360). The 90 day and 1 year median mRS were 2 (IQR 1-4) and 2 (IQR 1-4). The Pearson correlation coefficient between 90 day mRS and home-time within 90 days was -0.731 (p-value<.0001) (Figure). The c-index of 90 days home-time predicting 90 day mRS 0-2 was 0.837. The Pearson correlation coefficient between 1 year mRS and home-time within 1 year was -0.713 (p-value<.0001). The c-index of 1 year home-time predicting 12 month mRS 0-2 was 0.828. Conclusions: In a population of older ischemic stroke patients, home-time was correlated with and showed a strong level of agreement with mRS at 90 days and 1 year. Home-time may be able to serve as a novel, patient-centered, outcome measure for hospital/transitional stroke care.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".