Ischemic Stroke: Hospital Outcomes in California

2013-2014 Report

Executive Summary

Every year approximately 795,000 adult Americans suffer a stroke, and a stroke death occurs every four minutes¹. Stroke is the most common cause of adult long-term disability in the United States and a life-changing event that places a heavy burden on patients, families and caregivers.  This report focuses on the most common type of stroke, ischemic stroke, which occurs when an artery supplying blood to the brain becomes blocked.  This report does not provide information on hemorrhagic stroke, which is caused by a leaking or burst blood vessel.  For ischemic strokes, timely interventions are critical to reverse the damage; reduce mortality, morbidity and disability; and improve survivor quality of life.

This report provides information on the quality of ischemic stroke care at California acute care hospitals during 2013 to 2014, and provides performance ratings for more than 270 hospitals on two outcome measures—risk-adjusted 30-day mortality and risk-adjusted 30-day hospital readmission.  The outcome measures are statistically adjusted to account for differences in patient severity of illness at different hospitals, which allows for fair comparisons across all hospitals.

This is the third report on the quality of ischemic stroke care at California acute care hospitals produced by the Office of Statewide Health Planning and Development (OSHPD).  The first report “Ischemic Stroke: Hospital Outcomes in California, 2011-2012” was published in April 2015, and the second report based on 2012-2013 data was published in October 2015.  The information is intended to help consumers make more informed healthcare decisions, help payers and employers spend their healthcare dollars more wisely, and provide hospitals performance benchmarks they can use in their review of internal processes of care and quality improvement activities.

¹Mozaffarian D, Benjamin EJ, Go AS,  et al. Heart Disease and Stroke Statistics–2016 Update: A Report From the American Heart Association. Circulation. 2016;133:000-000.

Technical Details

Additional information about these quality measures can be found in the OSHPD Technical Note for Producing Ischemic Stroke: Hospital Outcomes in California, 2013-2014, and the Ischemic Stroke Outcomes Validation Study in California, 2006-2009.

Stroke Mortality and Readmission Results

Key Findings

Thirty-Day Mortality Findings

• There were 73,982 ischemic stroke hospitalizations in California between January 1, 2013 and December 31, 2014. Of these, 7,364 patients died within 30 days of hospital discharge for a statewide 30-day mortality rate of 10.0 percent, down from 10.4 percent in the 2012-13 report. Of these deaths, 3,481 (47.3 percent) occurred while the patient was in the hospital.
• Of the 274 hospitals in the report, 15 (5.5 percent) were rated significantly "Better" and 17 (6.2 percent) were rated significantly "Worse" than the state average.
• The average risk-adjusted mortality rate for the 17 hospitals rated "Worse" (18.1 percent) was more than three times higher than the average rate for the 15 hospitals rated "Better" (5.5 percent).
• Three hospitals (Garfield Medical Center, Cedars Sinai Medical Center, and White Memorial Medical Center) rated "Better" in the 2011-12 and 2012-13 reports were again rated "Better" in 2013-14. Four hospitals (Los Angeles County/University of Southern California Medical Center, San Joaquin General Hospital, Kaweah Delta Medical Center, and Woodland Memorial Hospital) rated "Worse" in the 2011-12 and 2012-13 reports were again rated "Worse" in 2013-14.

Thirty-Day Readmission Findings

• There were 67,888 ischemic stroke discharges included in the readmissions analysis (alive at discharge with valid Social Security numbers) between January 1, 2013 and December 31, 2014. Of these, 8,055 patients were readmitted within 30 days for a statewide 30-day readmission rate of 11.9 percent. This is a reduction from 12.4 percent as seen in the 2012-13 report.
• Of the 269 hospitals included in the readmission analysis, five were rated significantly "Better" (1.9 percent) and four were rated significantly "Worse" (1.5 percent) than the state average.
• The average risk-adjusted readmission rate for the four hospitals rated "Worse" (19.1 percent) was over three times higher than the average rate for the five "Better" rated hospitals (6.0 percent).
• There was no statistically significant correlation between hospital 30-day mortality rates and 30-day readmission rates, and no hospitals performed either "Better" or "Worse" on both measures.
• There were fewer "Worse" rated hospitals in the 2013-14 report (four) than in the 2011-12 report (seven) or 2012-13 report (seven).
• One hospital (Marian Regional Medical Center – Arroyo Grande) was rated "Better,"and one hospital (Saint Rose Hospital) was rated "Worse" in both the 2013-14 and 2012-13 reports. However, there were no overlaps either in "Better" or "Worse" rated hospitals between 2013-14 and 2011-12 reports.

2012-2013 Report

Executive Summary

Every year approximately 795,000 adult Americans suffer a stroke, and a stroke death occurs every four minutes¹. Stroke is the most common cause of adult long-term disability in the United States and a life-changing event that places a heavy burden on patients, families and caregivers. This report focuses on the most common type of stroke, ischemic stroke, which occurs when an artery supplying blood to the brain becomes blocked. It does not provide information on hemorrhagic stroke, which is caused by a leaking or burst blood vessel. For ischemic strokes, timely interventions are critical to reverse the damage; reduce mortality, morbidity and disability; and improve survivor quality of life.

This report provides information on the quality of ischemic stroke care at California acute care hospitals during 2012 to 2013 and provides performance ratings for more than 270 hospitals on two outcome measures-risk-adjusted 30-day mortality and 30-day hospital readmission. The outcome measures are statistically adjusted to account for differences in patient severity of illness at different hospitals, which allows for fair comparisons across all hospitals.

This is the second report on ischemic stroke quality of care produced by the Office of Statewide Health Planning and Development (OSHPD). The information is intended to help consumers make more informed healthcare decisions, help payers and employers spend their healthcare dollars more wisely, and provide hospitals performance benchmarks they can use in their review of internal processes of care and quality improvement activities.

¹Mozaffarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update: A Report From the American Heart Association. Circulation. 2015;131:434-441.

Technical Details

Additional information about these quality measures can be found in the OSHPD Technical Note for Producing Ischemic Stroke: Hospital Outcomes in California, 2012-2013, and the Ischemic Stroke Outcomes Validation Study in California, 2006-2009. (Appendices: A-I, Appendices: J-R).

Stroke Mortality and Readmission Results

Key Findings

Thirty-day Mortality Findings

• There were 70,447 ischemic stroke hospitalizations in California between January 1, 2012 and November 30, 2013. Of these, 7,340 patients died within 30 days of hospital admission for a statewide 30-day mortality rate of 10.4%, down slightly from 10.6% in the 2011-12 report. Of these deaths, 3,486 (47.5%) occurred while the patient was in the hospital.
• Of the 274 hospitals in the report, nine were rated significantly "Better" and nine were rated significantly "Worse" than the state average.
• The average risk-adjusted mortality rate for the nine hospitals rated "Worse" (17.8%) was more than three times higher than the average rate for the nine hospitals rated "Better" (5.7%).
• Of the nine hospitals rated "Better" in the 2011-12 report, three were again rated "Better" in 2012-13. Of the ten hospitals rated "Worse" in the 2011-12 report, five were rated "Worse" in 2012-13.

Thirty-day Readmission Findings

• There were 66,961 ischemic stroke discharges included in the readmissions analysis (alive at discharge with valid SSNs) between January 1, 2012 and November 30, 2013. Of these, 8,305 patients were readmitted within 30 days for a statewide 30-day readmission rate of 12.4%. This is a slight reduction from 12.8% seen in the 2011-12 report.
• Of the 271 hospitals included in the readmission analysis, three were rated significantly "Better" and seven were rated significantly "Worse" than the state average.
• The average risk-adjusted readmission rate for the seven hospitals rated "Worse" (19.0%) was over three times higher than the average rate for the three "Better" rated hospitals (5.5%).
• There was no statistically significant correlation between hospital 30-day mortality rates and readmission rates, and no hospitals performed either "Better" or "Worse" on both measures, though one hospital with a "Better" rating on mortality performed "Worse" on readmissions.
• There were fewer "Better" rated hospitals in the 2012-13 report (3) than in the 2011-12 report (12), and no overlap in "Better" hospitals between the two reports. Of the seven "Worse" rated hospitals in the 2011-12 report, three were again rated "Worse" in the 2012-13 report.

OSHPD also publishes the Agency for Research and Quality (AHRQ) Inpatient Mortality Indicator for Ischemic Stroke. Some of the key differences between the OSHPD and the AHRQ measures are provided in the Technical Note Producing the Ischemic Stroke : Hospital Outcomes in California Hospitals, 2012-2013.

2011-2012 Report

Executive Summary

Every year approximately 795,000 adult Americans suffer a stroke, and a stroke death occurs every four minutes.¹ Stroke is the most common cause of adult long-term disability in the United States and a life-changing event that places a heavy burden on patients, families and caregivers. This report focuses on the most common type of stroke, ischemic stroke, which occurs when an artery supplying blood to the brain becomes blocked. It does not provide information on hemorrhagic stroke, which is caused by a leaking or burst blood vessel. For ischemic strokes, timely interventions are critical to reverse the damage; reduce mortality, morbidity and disability; and improve survivor quality of life.

This report provides information on the quality of ischemic stroke care at California acute care hospitals during 2011 to 2012 and provides performance ratings for more than 270 hospitals on two outcome measures—risk-adjusted 30-day mortality and 30-day hospital readmission.  The outcome measures are statistically adjusted to account for differences in patient severity of illness at different hospitals, which allows for fair comparisons across all hospitals.

This is the first report on ischemic stroke quality of care developed and produced by the Office of Statewide Health Planning and Development (OSHPD). The information is intended to help consumers make more informed healthcare decisions, help payers and employers spend their healthcare dollars more wisely, and provide hospitals performance benchmarks they can use in their review of internal processes of care and quality improvement activities.

¹Go AS, Mozaffarian D, Roger VL, et al. Heart Disease and Stroke Statistics–2013 Update: A Report From the American Heart Association. Circulation. 2013;127:e6-e245.

Technical Details

Additional information about these quality measures can be found in the OSHPD Technical Note for Producing Ischemic Stroke: Hospital Outcomes in California, 2011-2012, and the Ischemic Stroke Outcomes Validation Study in California, 2006-2009. (Appendices: A-I, Appendices: J-R)

Stroke Mortality and Readmission Results

Key Findings

Thirty-day Mortality Findings

• There were 70,213 ischemic stroke hospitalizations in California between January 1, 2011 and November 30, 2012. Of these, 7,406 patients died within 30 days of hospital admission for a statewide 30-day mortality rate of 10.6%. Of these deaths, 3,601 (5.1%) occurred while the patient was in the hospital.
• Of the 276 hospitals in the report, nine were rated significantly “Better” and ten were rated significantly “Worse” than the state average.
• The average risk-adjusted mortality rate for the ten hospitals rated “Worse” (17.8%) was more than three times higher than the average rate for the nine hospitals rated “Better” (5.3%).
• Eight out of the nine hospitals rated “Better” were located in Los Angeles County.

Thirty-day Readmission Findings

• There were  66,612 ischemic stroke discharges included in the readmissions analysis (alive at discharge with valid SSNs) between January 1, 2011 and November 30, 2012. Of these, 8,527 patients were readmitted within 30 days for a statewide 30-day readmission rate of 12.8%.
• Of the 274 hospitals included in the readmission analysis, 12 were rated significantly “Better” and seven were rated significantly “Worse” than the state average.
• The average risk-adjusted readmission rate for the seven hospitals rated “Worse” (18.6%) was nearly three times higher than the average rate for the 12 “Better” rated hospitals (6.7%).
• There was no statistically significant correlation between hospital 30-day mortality rates and readmission rates, and no hospitals performed either “Better” or “Worse” on both measures, though one hospital with a “Better” rating on mortality performed “Worse” on readmissions.
• Of the 12 “Better” rated hospitals, seven were Kaiser Permanente hospitals. No other hospital system had more than one hospital rated “Better.”