• Gregg C Fonarow, Li Liang, Laine Thomas, Ying Xian, Jeffrey L Saver, Eric E Smith, Lee H Schwamm, Eric D Peterson, Adrian F Hernandez, Pamela W Duncan, Emily C O'Brien, Cheryl Bushnell, and Prvu Bettger Janet J From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L..
• From the Departments of Medicine (G.C.F) and Neurology (J.L.S), Ronald Reagan UCLA Medical Center; Duke Clinical Research Institute, Durham, NC (L.L., L.T., Y.X., E.D.P., A.F.H., E.C.O'B., J.P.-B.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC (P.W.D., C.B.). gfonarow@mednet.ucla.edu.
• Stroke. 2016 Mar 1; 47 (3): 836-42.

Background And PurposeStroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event.MethodsPatients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index.ResultsThere were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70-82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2-7]) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52-86) days and 349 (IQR, 303-360) days and median mRS were 2 (IQR, 1-4) and 2 (IQR, 1-4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient, -0.731; P<0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 (c-index, 0.837). Similar findings were observed at 1 year.ConclusionsIn a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.© 2016 American Heart Association, Inc.

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