Variability in intensive care utilization for intracerebral hemorrhage in the United States: Retrospective cohort study
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作者:
Daniel, David
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Icahn Sch Med Mt Sinai, Dept Neurol, New York, NY USAIcahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
Daniel, David
[1
]
Santos, Daniel
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Univ Penn, Dept Neurol, Philadelphia, PA USAIcahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
Santos, Daniel
[2
]
Maillie, Luke
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Icahn Sch Med Mt Sinai, New York, NY USAIcahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
Maillie, Luke
[3
]
Dhamoon, Mandip S.
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机构:
Icahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
1468 Madison Ave,Annenberg 2nd Floor,Room 2-44B, New York, NY 10029 USAIcahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
Dhamoon, Mandip S.
[1
,4
]
机构:
[1] Icahn Sch Med Mt Sinai, Dept Neurol, New York, NY USA
[2] Univ Penn, Dept Neurol, Philadelphia, PA USA
[3] Icahn Sch Med Mt Sinai, New York, NY USA
[4] 1468 Madison Ave,Annenberg 2nd Floor,Room 2-44B, New York, NY 10029 USA
Objectives: There are urban-rural geographic health disparities in intracerebral hem-orrhage (ICH) outcomes. However, there is limited data regarding the relationship between intensive care (ICU) availability and ICH outcomes. We examined whether ICU availability was a significant contributor to ICH outcomes by US geographic region. Materials and methods: We used de-identified Medicare inpatient datasets from January 2016 to December 2019 and identified all index ICH admissions, strat-ifying by ICU care received during the hospitalization. Distributions of teaching hospital status, quartile of ICH volume, hospital urban-rural designation, and ICU availability were obtained using chi-square test. Propensity-score matching was uti-lized to compare outcomes of more favorable outcome, inpatient mortality, and 30 -day all-cause readmissions by ICU availability at each hospital. Results: Out of a total of 119,891 hospitalizations for ICH, 66,306 (55.3%) received ICU-level care. Of hospitals that treated at least one ICH, 42.6% did not provide ICU level care for any ICH admission during the study period. Teaching hospitals (48.0% vs 7.0%; p<0.0001), hospitals with higher ICH case volumes (p<0.0001) and in larger metro-politan areas (p<0.0001) were more likely to have an ICU available. Propensity score-matched models showed that hospital ICU availability was associated with a lower likelihood of inpatient mortality (29.4% vs 33.7%; p=0.0016) Conclusions: Rural-urban disparities in ICH outcomes are likely multifactorial, but ICU availability likely contributes to the disparity. Additional studies are necessary to elucidate other contributing mechanisms.
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Agency for Healthcare Research and Quality, 2019, CLIN CLASSIFICATIONS
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Univ Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Guerrero, Waldo R.
Gonzales, Nicole R.
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McGovern Med Sch, Houston, TX USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Gonzales, Nicole R.
Sekar, Padmini
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Sekar, Padmini
Kawano-Castillo, Jorge
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McGovern Med Sch, Houston, TX USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Kawano-Castillo, Jorge
Moomaw, Charles J.
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Moomaw, Charles J.
Worrall, Bradford B.
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Univ Virginia, Dept Neurol, Charlottesville, VA USA
Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Worrall, Bradford B.
Langefeld, Carl D.
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Wake Forest Sch Med, Div Publ Hlth Sci, Genom Dept Biostat Sci, Ctr Publ Hlth, Winston Salem, NC USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Langefeld, Carl D.
Martini, Sharyl R.
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Baylor Coll Med, Dept Neurol, Houston, TX 77030 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Martini, Sharyl R.
Flaherty, Matthew L.
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Flaherty, Matthew L.
Sheth, Kevin N.
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Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Sheth, Kevin N.
Osborne, Jennifer
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Osborne, Jennifer
Woo, Daniel
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
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Yale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Yale Univ, Yale Sch Med, Ctr Neuroepidemiol & Clin Neurol Res, New Haven, CT USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Hwang, David Y.
George, Benjamin P.
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Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
George, Benjamin P.
Kelly, Adam G.
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Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Kelly, Adam G.
Schneider, Eric B.
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Brigham & Womens Hosp, Ctr Surg & Publ Hlth, 75 Francis St, Boston, MA 02115 USA
Johns Hopkins Sch Med, Dept Surg, Baltimore, MD USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Schneider, Eric B.
Sheth, Kevin N.
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Yale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Yale Univ, Yale Sch Med, Ctr Neuroepidemiol & Clin Neurol Res, New Haven, CT USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Sheth, Kevin N.
Holloway, Robert G.
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Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
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Univ Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Guerrero, Waldo R.
Gonzales, Nicole R.
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McGovern Med Sch, Houston, TX USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Gonzales, Nicole R.
Sekar, Padmini
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Sekar, Padmini
Kawano-Castillo, Jorge
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McGovern Med Sch, Houston, TX USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Kawano-Castillo, Jorge
Moomaw, Charles J.
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Moomaw, Charles J.
Worrall, Bradford B.
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Univ Virginia, Dept Neurol, Charlottesville, VA USA
Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Worrall, Bradford B.
Langefeld, Carl D.
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h-index: 0
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Wake Forest Sch Med, Div Publ Hlth Sci, Genom Dept Biostat Sci, Ctr Publ Hlth, Winston Salem, NC USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Langefeld, Carl D.
Martini, Sharyl R.
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h-index: 0
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Baylor Coll Med, Dept Neurol, Houston, TX 77030 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Martini, Sharyl R.
Flaherty, Matthew L.
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h-index: 0
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Flaherty, Matthew L.
Sheth, Kevin N.
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Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Sheth, Kevin N.
Osborne, Jennifer
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
Osborne, Jennifer
Woo, Daniel
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Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USAUniv Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
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Yale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Yale Univ, Yale Sch Med, Ctr Neuroepidemiol & Clin Neurol Res, New Haven, CT USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Hwang, David Y.
George, Benjamin P.
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h-index: 0
机构:
Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
George, Benjamin P.
Kelly, Adam G.
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机构:
Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Kelly, Adam G.
Schneider, Eric B.
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h-index: 0
机构:
Brigham & Womens Hosp, Ctr Surg & Publ Hlth, 75 Francis St, Boston, MA 02115 USA
Johns Hopkins Sch Med, Dept Surg, Baltimore, MD USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Schneider, Eric B.
Sheth, Kevin N.
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h-index: 0
机构:
Yale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Yale Univ, Yale Sch Med, Ctr Neuroepidemiol & Clin Neurol Res, New Haven, CT USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA
Sheth, Kevin N.
Holloway, Robert G.
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h-index: 0
机构:
Univ Rochester, Sch Med & Dent, Dept Neurol, Rochester, NY 14642 USA
Johns Hopkins Sch Med, Baltimore, MD USAYale Sch Med, Div Neurocrit Care & Emergency Neurol, Dept Neurol, POB 208018, New Haven, CT 06520 USA