Katia Noyes

Association between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality

CONTEXT Although stroke centers are widely accepted and supported, little is known about their effect on patient outcomes. OBJECTIVE To examine the association between admission to stroke centers for acute ischemic stroke and mortality. DESIGN, SETTING, AND PARTICIPANTS Observational study using data from the New York Statewide Planning and Research Cooperative System. We compared mortality for patients admitted with acute ischemic stroke (n = 30,947) between 2005 and 2006 at designated stroke centers and nondesignated hospitals using differential distance to hospitals as an instrumental variable to adjust for potential prehospital selection bias. Patients were followed up for mortality for 1 year after the index hospitalization through 2007. To assess whether our findings were specific to stroke, we also compared mortality for patients admitted with gastrointestinal hemorrhage (n = 39,409) or acute myocardial infarction (n = 40,024) at designated stroke centers and nondesignated hospitals. MAIN OUTCOME MEASURE Thirty-day all-cause mortality. RESULTS Among 30,947 patients with acute ischemic stroke, 15,297 (49.4%) were admitted to designated stroke centers. Using the instrumental variable analysis, admission to designated stroke centers was associated with lower 30-day all-cause mortality (10.1% vs 12.5%; adjusted mortality difference, -2.5%; 95% confidence interval [CI], -3.6% to -1.4%; P < .001) and greater use of thrombolytic therapy (4.8% vs 1.7%; adjusted difference, 2.2%; 95% CI, 1.6% to 2.8%; P < .001). Differences in mortality also were observed at 1-day, 7-day, and 1-year follow-up. The outcome differences were specific for stroke, as stroke centers and nondesignated hospitals had similar 30-day all-cause mortality rates among those with gastrointestinal hemorrhage (5.0% vs 5.8%; adjusted mortality difference, +0.3%; 95% CI, -0.5% to 1.0%; P = .50) or acute myocardial infarction (10.5% vs 12.7%; adjusted mortality difference, +0.1%; 95% CI, -0.9% to 1.1%; P = .83). CONCLUSION Among patients with acute ischemic stroke, admission to a designated stroke center was associated with modestly lower mortality and more frequent use of thrombolytic therapy.

Sex and racial differences in bladder cancer presentation and mortality in the US

Sex, race, and age at diagnosis have a significant impact on mortality from bladder cancer (BC). Women, African Americans of both sexes, and the elderly, all experience higher mortality rates. Tumor grade, stage, and histologic type at presentation also affect outcome. To determine whether age and tumor characteristics alone explain the excess hazard of death from BC observed in some demographic groups, the authors queried the Surveillance, Epidemiology, and End Results (SEER) limited‐use database for the presentations of and outcomes from BC between 1990 and 2005.

Improved Survival Associated with Prophylactic Implantable Defibrillators in Elderly Patients with Prior Myocardial Infarction and Depressed Ventricular Function: A MADIT‐II Substudy

Introduction: We aim to evaluate the mortality benefit from defibrillator therapy in eligible elderly patients. Effective primary prevention of sudden cardiac death with implantable cardioverter defibrillators is well demonstrated in patients with coronary disease and depressed ventricular function.

Economic burden associated with Parkinson's disease on elderly Medicare beneficiaries.

We evaluated medical utilization and economic burden of self‐reported Parkinsons disease (PD) on patients and society. Using the 1992–2000 Medicare Current Beneficiary Survey, we compared health care utilization and expenditures (in 2002 U.S. dollars) of Medicare subscribers with and without PD, adjusting for sociodemographic characteristics and comorbidities. PD patients used significantly more health care services of all categories and paid significantly more out of pocket for their medical services than other elderly (mean ± SE,

Cost-effectiveness of disease-modifying therapy for multiple sclerosis A population-based study

5,532 ±

Treatment of nonmuscle invading bladder cancer: do physicians in the United States practice evidence based medicine? The use and economic implications of intravesical chemotherapy after transurethral resection of bladder tumors.

329 vs.

Teaching and evaluating first and second year medical students' practice of evidence-based medicine

2,187 ±

Acute Illness Care Patterns Change With Use of Telemedicine

38; P < 0.001). After adjusting for other factors, PD patients had higher annual health care expenses than beneficiaries without PD (

Accuracy of Medicare claims data in identifying Parkinsonism cases: comparison with the Medicare current beneficiary survey.

18,528 vs.

Health-related quality of life consequences of implantable cardioverter defibrillators : Results from MADIT II

10,818; P < 0.001). PD patients were more likely to use medical care (OR = 3.77; 95% CI = 1.44–9.88), in particular for long‐term care (OR = 3.80; 95% CI = 3.02–4.79) and home health care (OR = 2.08; 95% CI = 1.76–2.46). PD is associated with a significant economic burden to patients and society. Although more research is needed to understand the relationship between PD and medical expenditures and utilization, these findings have important implications for health care providers and payers that serve PD populations.