Introduction: Home time has been proposed as a surrogate for functional outcome in ischemic stroke, and is also a highly valued patient-centered outcome that reflects resource utilization. In prospective cohort studies and clinical trials, higher home time has been correlated with lower disability; however, the requirement for informed consent results in selection bias. Therefore, the population distributions of home time after stroke are currently unknown. Additionally, home time distributions have not been reported in hemorrhagic stroke and transient ischemic attack (TIA). We developed a novel administrative data algorithm to compare home time distributions after hospital admission for cerebrovascular events in the population of Alberta, Canada.
Methods: Home time was defined as the number of nights not spent in an institution, including acute-care, inpatient rehabilitation facilities, and long-term care, in the 90 days after admission for a cerebrovascular event. Community-dwelling residents of Alberta, Canada with a valid healthcare number admitted for a cerebrovascular event between April 2012 and June 2015 were included. We used the Kruskal-Wallis test to compare the median home-times according to stroke type: ischemic stroke (IS), TIA, or hemorrhagic stroke (HS), including intracerebral and subarachnoid hemorrhage. We correlated admitting age and home time with Spearman correlations and assessed sex and home time with Wilcoxon Rank Sum.
Results: A total of 12520 admissions were identified, the median age was 74 years (IQR 22), and 53% were male. There were 8482 (68%) IS, 2434 (19%) TIA, and 1604 (13%) HS. The median (IQR) home time by stroke type was 72 nights (85) for IS, 87 nights (6) for TIA, and 29 nights (79) for HS (p<0.001). For each stroke type, lower home time was correlated with higher age (IS: r=-0.35; TIA: r=-0.31; HS: r=-0.33; p<0.001 for each comparison) and female sex (p≤0.001).
Conclusion: In this population with universal healthcare access, TIA had the highest home time (i.e. best outcomes) whereas hemorrhagic stroke had the lowest, consistent with expected functional outcomes based on prospective cohort studies. Home time may be a useful metric to track patient outcomes and healthcare utilization based on administrative health data.