• Michael P Thompson, Xin Zhao, Kimon Bekelis, Daniel J Gottlieb, Gregg C Fonarow, Phillip J Schulte, Ying Xian, Barbara L Lytle, Lee H Schwamm, Eric E Smith, and Mathew J Reeves.
• From the Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN (M.P.T.); Duke Clinical Research Institute, Durham, NC (X.Z., Y.X., B.L.L.); Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (K.B., D.J.G.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA (G.C.F.); Department of Health Science Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Neurology, Massachusetts General Hospital, Boston, MA (L.H.S.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.); and Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (M.J.R.). mthompson@uthsc.edu.
• Circ Cardiovasc Qual. 2017 Aug 1; 10 (8).

BackgroundWe explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation.Methods And ResultsThis ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation (r=-0.17; P=0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained.ConclusionsThirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained.© 2017 American Heart Association, Inc.

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