This country lacks a cohesive, informative surveillance system for vascular disease that can provide insights into national patterns of cerebrovascular disease and reveal national trends over time. Our overall goal is to build a surveillance system for the majority of patients admitted to the hospital with stroke in the United States, patients age > 65 years who are enrolled in the Medicare fee-for-service (FFS) option. We have assembled an unprecedented national resource by creating a longitudinal Medicare database for patients hospitalized with vascular diagnoses over the years 1992-1999, with ability to add years (through 2003 as part of this project). Since our original submission, our team has overcome considerable technical difficulties to create this database. This work has entailed transforming more than 5,000 data tapes into a viable data resource containing more than a terabyte of data. Previous studies using Medicare databases have employed a cross-sectional approach, not linking, at the patient level, the entire Medicare Part A (hospital admissions) database over time. No other organization or institution, not even the Centers for Medicare & Medicaid Services (CMS), has developed such a database. Our objective is to provide the most comprehensive evaluation of stroke and short-term mortality outcomes among hospitalized Medicare FFS beneficiaries in the United States. The evaluation will encompass the entire United States and span more than a decade. Accordingly, we propose the following specific aims: 1. To determine rates of stroke hospitalizations among Medicare beneficiaries in the United States. 2. To determine rates of hospital and 30-day mortality following stroke hospitalization among Medicare beneficiaries in the United States. 3. To determine patterns of stroke hospitalization among subgroups including by age, race and ethnicity, and by economic, political, and geographic characteristics. 4. To measure trends in stroke hospitalization rates over time Our work will help better define the burden of stroke among the elderly, inform policy-makers and clinicians in planning for the health care needs of stroke patients, and help identify targets for interventions to enhance the care of patients with stroke.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS043322-03
Application #
7174187
Study Section
Epidemiology of Clinical Disorders and Aging Study Section (ECDA)
Program Officer
Lynch, John K
Project Start
2005-02-15
Project End
2009-01-31
Budget Start
2007-02-01
Budget End
2008-01-31
Support Year
3
Fiscal Year
2007
Total Cost
$250,858
Indirect Cost
Name
Yale University
Department
Neurology
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Lichtman, Judith H; Jones, Sara B; Wang, Yun et al. (2013) Seasonal variation in 30-day mortality after stroke: teaching versus nonteaching hospitals. Stroke 44:531-3
Lichtman, Judith H; Leifheit-Limson, Erica C; Jones, Sara B et al. (2013) Preventable readmissions within 30 days of ischemic stroke among Medicare beneficiaries. Stroke 44:3429-35
Lichtman, Judith H; Leifheit-Limson, Erica C; Jones, Sara B et al. (2012) 30-Day risk-standardized mortality and readmission rates after ischemic stroke in critical access hospitals. Stroke 43:2741-7
Lichtman, J H; Jones, S B; Wang, Y et al. (2011) Outcomes after ischemic stroke for hospitals with and without Joint Commission-certified primary stroke centers. Neurology 76:1976-82
Lichtman, Judith H; Jones, Sara B; Leifheit-Limson, Erica C et al. (2011) 30-day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission primary stroke center-certified and noncertified hospitals. Stroke 42:3387-91
Allen, Norrina B; Holford, Theodore R; Bracken, Michael B et al. (2010) Trends in one-year recurrent ischemic stroke among the elderly in the USA: 1994-2002. Cerebrovasc Dis 30:525-32
Lichtman, Judith H; Leifheit-Limson, Erica C; Jones, Sara B et al. (2010) Predictors of hospital readmission after stroke: a systematic review. Stroke 41:2525-33
Allen, Norrina B; Holford, Theodore R; Bracken, Michael B et al. (2010) Geographic variation in one-year recurrent ischemic stroke rates for elderly Medicare beneficiaries in the USA. Neuroepidemiology 34:123-9
Lichtman, Judith H; Jones, Sara B; Wang, Yun et al. (2010) Postendarterectomy mortality in octogenarians and nonagenarians in the USA from 1993 to 1999. Cerebrovasc Dis 29:154-61
Lichtman, Judith H; Allen, Norrina B; Wang, Yun et al. (2009) Stroke patient outcomes in US hospitals before the start of the Joint Commission Primary Stroke Center certification program. Stroke 40:3574-9

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