The candidate's long-term goals are to become an independent clinical researcher and make significant contributions to the study of stroke management and outcomes. To fulfill these goals, the candidate proposes a 5-year plan to learn research methodologies related to assessing and analyzing stroke management in the community setting. This will involve formal training as well as comprehensive research on pneumonia as a complication of acute stroke. Pneumonia is a frequent and serious complication occurring after stroke, yet the predictors and preventability of pneumonia, and its effect on outcomes after stroke, are poorly known.
The Aims of the proposed study are to use a large community-based cohort of Medicare patients hospitalized for acute stroke to: 1) Evaluate the effect of pneumonia on length of stay, rate of discharge to home, and 30-day readmissions. 2) Determine the effect of pneumonia on hospital costs. 3) Evaluate the effect of process of care measures on occurrence of pneumonia. 4) Develop a clinically useful prediction rule to identify patients most likely to benefit from preventive interventions. A retrospective cohort will be used to evaluate Primary Aims 1 and 2 and nested case-control studies will be performed to evaluate Primary Aims 3 and 4. For the first two Aims, the independent effect of pneumonia on outcomes and costs will be determined using data on 11, 286 stroke patients hospitalized in the Cleveland region from 1991-1997. Regression analyses will be performed with adjustments for both susceptibility and selection bias. To evaluate Primary Aims 3 and 4, a supplemental chart review will be performed for each case and control in the 2 nested case-control studies. Patients with pneumonia (n = 400) in a subset of 19 hospitals will serve as cases for both.
For Aim 3, to isolate the effect of process of care measures, controls for Aim 3 will be selected using multivariate matching to cases on patient characteristics correlated with their propensity for pneumonia.
For Aim 4, a random sample of patients will serve as controls. Products of this investigation will fill important gaps in knowledge about a serious compilation of stroke and guide further research and patient care to prevent stroke-related pneumonia. Combined with rigorous coursework in research methods, this body of work will establish a solid foundation for the candidate's long-term goals. ? ?
| Katzan, I L; Dawson, N V; Thomas, C L et al. (2007) The cost of pneumonia after acute stroke. Neurology 68:1938-43 |
