Stroke Mortality in New Jersey Hospitals 2002 - 2005
Health Care Quality Assessment Office of the Commissioner New Jersey Department of Health and Senior Services
March 2008
Jon S. Corzine Governor
Heather Howard Commissioner
Stroke Mortality in New Jersey Hospitals 2002 - 2005
Cynthia M. Kirchner, M.P.H. Senior Policy Advisor to the Commissioner
Stroke Report Preparation Team
Emmanuel Noggoh, Director Abate Mammo, PhD, Program Manager Markos Ezra, PhD, Research Scientist I Debra Virgilio, RN, M.P.H.
March 2008
Table of Contents
Page Introduction .....................................................................................................................1 Types of Strokes .............................................................................................................1 Acute Stroke as Indicator of Quality of Care ....................................................................2 Identifying Acute Stroke Patients in the UB Database .....................................................3 Demographic Characteristics of Acute Stroke Patients....................................................5 Severity of Illness and Risk of Mortality ..........................................................................7 Acute Stroke Mortality in New Jersey Hospitals.............................................................10 Discussion .....................................................................................................................14 References ....................................................................................................................15
Tables
Table 1. Primary Diagnosis Codes (ICD-9-CM) for Acute Stroke...................................4 Table 2. Demographic Characteristics of Acute Stroke Patients, 2005..........................6 Table 3. Severity of Illness by Demographic Characteristics of Acute Stroke Patients, 2005..................................................................................................8 Table 4. Risk of Mortality by Demographic Characteristics of Acute Stroke Patients, 2005..................................................................................................9 Table 5. Risk-Adjusted Acute Stroke Mortality (per 100) in New Jersey Hospitals, 2002-2005 .....................................................................................11
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Introduction
Stroke is a major health problem both in New Jersey and nationally that can cause permanent disability and death. According to the 2005 Behavioral Risk Factor Surveillance System (BRFSS), 2.6% (5,839,000) Americans and 2.1% (146,000) New Jerseyans age 18 or older had a history of stroke (MMWR, 2007). Every year about 750,000 Americans suffer from stroke, some 160,000 die from it, and thousands of the survivors have their lives changed forever because of disability. For people over 55, the risk of a stroke is over one in six. Stroke is the third-leading cause of death in America, and the number one cause of disability. Stroke mortality is one of 32 inpatient quality indicators (IQIs) identified by the Agency for Healthcare Research and Quality (AHRQ). Background information on the development of AHRQ modules, IQI measures and a complete list of IQIs can be obtained in reports compiled by Health Care Quality Assessment (HCQA) staff for New Jersey hospitals at www.nj.gov/health/healthcarequality/qi.shtml. The current report uses data on patients discharged between 2002 and 2005 from New Jersey acute care hospitals who had acute stroke as their primary diagnosis. The report is designed to provide baseline information for the stroke project that is recently launched by the Department. The Stroke Project is charged with the monitoring and evaluation of stroke services outcomes among hospitals designated as ‘stroke centers’. This report is not intended as the source of information on hospital quality.
Types of Strokes
There are three broadly identified stroke types: Hemorrhagic stroke, Ischemic Stroke, and Transient Ischemic Attack. Hemorrhagic Stroke, which is the most serious, occurs when a blood vessel in the brain ruptures. Hemorrhage can occur in several ways. One common way is a weak spot in an artery wall that stretches or balloons out under pressure and eventually ruptures. It can also occur when the arterial wall breaks open, due to plaque or fatty deposit build-up. Ischemic Stroke refers to a condition when a blood vessel in the brain becomes blocked, suddenly decreasing or stopping blood flow and causing brain damage. The most common reason is developing a blood clot. This type of stroke accounts for 80 percent of all strokes. Transient Ischemic Attack (TIA), also known as a "mini-stroke," refers to a condition when the blood flow to part of the brain is cut off for a short period of time, usually less than 15 minutes. A TIA is a warning sign and _________________________________________________________________________ 1
should be treated seriously. Of the approximately 50,000 Americans that have a TIA each year, about one-third will have a stroke in the near future. So, if a person experiences the symptoms of a stroke for only a short period of time, then the symptoms go away, the person may be having a "mini stroke." Although a TIA may not leave noticeable damage, it is important to talk to a doctor immediately. Regardless of which type of stroke, the most common signs of a stroke include: • • • • • Sudden numbness or weakness of the face, arm or leg - especially on one side of the body Sudden trouble seeing in one or both eyes Sudden trouble walking, dizziness, loss of balance, or coordination Sudden severe headache with no known cause Sudden confusion or trouble speaking.
Learning about stroke types and knowing what to do when they occur could save life. A stroke is a medical emergency and should be treated as such. If anyone experiences any of the above signs or symptoms, one should call 911 immediately. Treatment can be more effective if the stroke victim receives it within a short time after the event.
Acute Stroke as Indicator of Quality of Care
Acute Stroke is a disruption of the blood supply to the brain. A stroke occurs when a blood vessel (artery) that supplies blood and nutrients to the brain bursts or is blocked by a blood clot or some other particle. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours. As a result, the part of the body controlled by the damaged section of the brain cannot function properly. If medical treatment begins soon after symptoms are noticed, fewer brain cells may be permanently damaged. Treatment for stroke must be timely and efficient to prevent brain tissue death, and differs significantly based on which of the two types of stroke a patient has suffered. For example, clot-busting drugs are appropriate for strokes caused by clots, but could be fatal in the case of a burst blood vessel. Despite its vital role in reducing death, however, hospital care may have a relatively modest impact on patient survival, and most stroke deaths occur after the initial acute hospitalization. The relationship of stroke to quality is that better processes of care may reduce short-term mortality, which represents better quality. Mortality rates will vary based on the cause of the stroke, the severity of the stroke, other patient illnesses, speed of arrival at the hospital, and speed of diagnosis of the type of stroke. Empirical evidence shows that stroke mortality is positively related to mortality indicators for pneumonia, gastrointestinal ____________________________________________________________________________ 2
hemorrhage, and congestive heart failure. Moreover, clinical factors, including use of mechanical ventilation on the first day, may vary by hospital and influence mortality. Coma at presentation and a history of previous stroke substantially increase the mortality of patients admitted with stroke. The mortality rate for Acute Stroke is defined as the number of in-hospital deaths per 100 patients with principal diagnosis code of stroke (age 18 years and older). However, some patients are sicker or more difficult to treat, and some hospitals admit more of these complex patients than others. Each hospital’s death rate is adjusted to account for differences in patient factors, but the adjustment is not perfect. Risk adjustment for clinical factors (or at a minimum, severity of illness or risk of mortality derived from the All Patient Refined Diagnosis Related Groups (APR-DRGs)) is recommended. The APR-DRG generates severity of illness or risk of mortality for each patient by applying algorithms on the Uniform Billing data (UB) data. This process provides us with tools that we can use to account for differences in patients’ severity of illness and risk of mortality, which in turn allows for comparisons among hospitals with different mixes of patient characteristics. Cases with missing discharge disposition, patients transferred to another short-term hospital, MDC 14 (pregnancy, childbirth, and puerperium), and MDC 15 (newborns and other neonates) are excluded from the calculation of the risk-adjusted rate.
Identifying Acute Stroke Patients in the UB Database
The UB database collects data on patients admitted to acute care hospitals in New Jersey. On each patient, up to nine diagnostic codes are reported, following the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) of which the first one is considered the primary diagnosis code. The UB database also contains up to eight procedure codes that allow the study of procedures performed. Table 1 presents the primary diagnosis codes used to identify stroke patients admitted in New Jersey acute care hospitals. Stroke care in outpatient settings is not included in the UB database.
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Table 1. Primary Diagnosis Codes (ICD-9-CM) for Acute Stroke
Diagnosis Codes
Description
430 431 4320 4321 4329 43301 43311 43321 43331 43381 43391 43401 43411 43491 436*
Subarachnoid Hemorrhage Intracerebral Hemorrhage Nontraumatic Extradural Hemorrhage Subdural Hemorrhage Unspecified Intracranial Hemorrhage Basilar Artery Occlusion with Cerebral Infarction Carotid Artery Occlusion with Cerebral Infarction Vertebral Artery Occlusion with Cerebral Infarction Multiple and Bilateral Precerebral Occlusion with Infarction Other Specified Precerebral Occlusion with Cerebral Infraction Unspecified Precerebral Occlusion with Cerebral Infarction Cerebral Thrombosis with Cerebral Infarction Cerebral Embolism with Cerebral Infarction Unspecified Cerebral Artery Occlusion with Cerebral Infarction Acute, but Ill-defined Cerebrovascular Disease
Source: New Jersey 2005 and 2006 UB Data * This code is excluded in the latest AHRQ IQI Module and has not been used in the analysis .
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Demographic Characteristics of Stroke Patients
In order to provide a general picture of the stroke patient population, Table 2 presents the demographic characteristics of patients using data from the 2005 UB database. There were 14,381 patients whose primary diagnosis was stroke. Over 70 percent (72.3%) of these patients were 65 years old or older and suggests that stroke is primarily associated with the elderly. Only 8.0% were less than 50 years old and 52.9% of stroke patients were female. By Race/ethnicity, 67.5% of stroke patients in 2005 were non-Hispanic White and 17.5% were non-Hispanic black. Hispanics accounted for only 8.0%. Given that most stroke patients are 65 years old or older, the lower proportion of Hispanics among stroke patients suggests that this population group has younger members. As suggested by the relative old age of the stroke patient population, most of the hospitalizations were paid for by Medicare (64.6%) followed by private insurance providers (22.2%). Medicaid accounted for only 2.1%. UB data do not adequately distinguish between Health Maintenance Organizations (HMOs) serving commercial and Medicaid members. Most New Jersey Medicaid clients under age 65 are enrolled in an HMO.
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Table 2. Demographic Characteristics of Acute Stroke Patients, 2005
Categories Age Group: 18-34 35-49 50-64 65+ Total Sex: Male Female Total Ethnicity: White/Non-Hisp Black/Non-Hisp Asian/Non-Hisp Hispanic Total Payer: Medicare Medicaid Private Self Pay Other Total
Stroke Patients 159 975 2,855 10,392 14,381 6,767 7,614 14,381 9,713 2,519 999 1,150 14,381 9,290 295 3,186 685 925 14,381
Column % 1.2 6.8 19.9 72.3 100.0 47.1 52.9 100.0 67.5 17.5 7.0 8.0 100.0 64.6 2.1 22.2 4.8 6.4 100.0
Source: New Jersey 2005 UB Data.
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Severity of Illness and Risk of Mortality
Tables 3 and 4 present demographic characteristics of stroke patients by severity of illness and risk of mortality, respectively. Severity of illness and risk of mortality are obtained by using 3-M’s proprietary grouper known as the All Patient Refined Diagnosis Related Groups (APR-DRG) which is a clinical model that expands on Diagnosis Related Groups (DRGs) on the basis of patient demographics and secondary diagnoses to identify patients with low, moderate, and high severity of illness or risk of mortality. Table 3 shows that a great majority of stroke patients in age groups 50-64 and 65+ are hospitalized with either moderate or high level of severity of illness. Only 17.0% of those in age group 50-64 and 11.2% of those 65 years or older are reported to be with low severity of illness. Close to 87% (86.9%) of stroke patients had either moderate (48.0%) or high (38.9%) severity of illness as assessed using the APR-DRG grouper. By comparison, 15.7% of the 1,628 deaths and 81.2% of the deaths, respectively, were among moderate severity and high severity of illness patients. Table 4 shows distribution of stroke hospitalizations including deaths due to acute stroke by risk of mortality as per the APR-DRG classification. Overall, of the 14,381 stroke hospitalizations, 47.9% were admitted as patients with moderate risk of mortality while 25.5% were considered as patients with high risk of mortality. Of the 1,628 deaths due to acute stroke, 77.6% were classified as patients with high risk of mortality. Table 4 also presents crude death rates by age group, sex, race/ethnicity and Insurance (Payer). The crude (unadjusted) death rate among stroke patients in 2005 was 11.3% with Asians having the highest rate (12.8%) followed by whites (11.8%).
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Table 3. Severity of Illness by Demographic Characteristics of Acute Stroke Patients, 2005
Severity of Illness* Category Age Group: 18-34 35-49 50-64 65+ Sex: Male Female Ethnicity: White/Non-Hisp Black/Non-Hisp Asian/Non-Hisp Hispanic Payer: Medicare Medicaid Private Self Pay Other Total Death Distribution Crude Death Rate Source: New Jersey 2005 UB data. * Obtained from APR-DRG. Numbers represent row percents. Low 23.3 20.9 17.0 11.2 14.6 11.8 12.6 12.2 17.7 15.3 10.4 8.8 18.4 21.8 17.5 13.1 3.1 2.7 Moderate 37.1 45.8 51.6 47.4 47.5 48.4 48.0 49.1 45.2 48.0 47.0 44.7 50.3 47.9 50.3 48.0 15.7 3.7 High 39.6 33.2 31.5 41.5 37.9 39.8 39.4 38.7 37.0 36.7 42.6 46.4 31.3 30.4 32.2 38.9 81.2 23.6 Total 159 975 2,855 10,392 6,767 7,614 9,713 2,519 999 1,150 9,290 295 3,186 685 925 14,381 1,628 1,628
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Table 4. Risk of Mortality by Demographic Characteristics of Acute Stroke Patients, 2005
Risk of Mortality* Number of Stroke Patients
Total In-hospital Deaths Crude Death Rate
Category
Low
Moderate
High
Age Group: 18-34 35-49 50-64 65+ Sex: Male Female Ethnicity: White/Non-Hisp Black/Non-Hisp Asian/Non-Hisp Hispanic Payer: Medicare Medicaid Private Self Pay Other Total Death Distribution Crude Death Rate
47.2 52.7 56.6 15.7 31.4 22.4 23.0 34.0 32.6 36.1 15.4 36.3 48.8 51.7 41.5 26.6 1.7 0.7
25.8 24.4 24.1 56.9 42.8 52.4 51.4 41.2 38.0 41.0 56.8 33.6 31.6 25.0 35.5 47.9 20.8 4.9
27.0 22.9 19.3 27.4 25.9 25.2 25.6 24.7 29.3 22.9 27.8 30.2 19.6 23.4 23.0 25.5 77.6 34.4
159 975 2,855 10,392 6,767 7,614 9,713 2,519 999 1,150 9,290 295 3,186 685 925 14,381
16 95 240 1,277 773 855 1,147 233 128 120 1,118 29 290 93 98 1,628
10.1 9.7 8.4 12.3 11.4 11.2 11.8 9.2 12.8 10.4 12.0 9.8 9.1 13.6 10.6 11.3
Source: New Jersey 2005 and 2006 UB Data. * Obtained from APR-DRG. Numbers represent row percents.
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Acute Stroke Mortality in New Jersey Hospitals
Analysis presented in this section is based on New Jersey UB data and the AHRQ IQI module. Table 5 presents number of stroke patients, number of inhospital deaths and risk-adjusted mortality rates for acute stroke in New Jersey hospitals for years 2002 to 2005. The statewide volume of stroke patients declined from 15,123 in 2002 to 14,381 in 2005, almost a five percent decline (4.9%). The risk-adjusted death rate is the best estimate since it would provide what the hospital's rate would have been if the hospital had a mix of patients identical to the statewide-average patient mix for that year. The risk-adjusted rate reflects the age and sex distribution as well as the APR-DRG distribution of the data in the baseline file. Readers are advised to use the statewide rate as point of reference while comparing hospital-specific rates. The following are the salient observations in the Table. • The risk-adjusted stroke death rate declined from 12.1% in 2002 to 10.0% in 2005 and represents a 17.3% decline. In 2003, the average stroke death rate in the United States was 10.6%. Literature suggests that only 10-15% of stroke patients die during hospitalization. Hospital-specific risk-adjusted stroke mortality rates for 2002 ranged from a low of 5.1% (Barnert hospital) to a high of 18.0% (Lourdes Medical Center of Burlington County). In 2005, the rate ranged from a low of 0.0% (Deborah Heart and Lung Center) to 28.3% (St. Clare's Hospital Sussex). Rates based on a denominator (volume) of less than 30 are to be used with caution.
•
It is important to note that hospitals with rehabilitation programs may have higher mortality rates. Another factor that affects in-hospital death rates may be early post-operative discharge, which may shift deaths to skilled nursing facilities or outpatient settings. This may lead to biased comparisons among hospitals with different mean lengths of stay. This suggests that a fair comparison of hospitals by risk-adjusted mortality should consider some post discharge deaths as well as in-hospital deaths much like it is done for cardiac surgery center evaluations.
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Table 5. Risk-Adjusted Acute Stroke Mortality (per 100) in New Jersey Hospitals, 2002-2005
2002
Hospital Name
National (National Healthcare Quality Report) National (AHRQ Documentation)
2003
Rate
NA 11.0
2004
Rate
11.0 10.6
2005
Rate
10.5 NA
Volume
Deaths
Volume
Deaths
Volume
Deaths
Volume Deaths
Rate
NA NA
Statewide Atlanticare Regional Medical Center-City Atlanticare Regional Medical Center-Mainland Barnert Hospital Bayonne Medical Center Bayshore Community Hospital Bergen Regional Medical Center Cape Regional Medical Center Capital Health System at Fuld Capital Health System at Mercer Cathedral-St. James Hospital Cathedral-St. Michael's Medical Center CentraState Medical Center Chilton Memorial Hospital Christ Hospital Clara Maass Medical Center Columbus Hospital Community Medical Center Cooper Hospital/University Medical Center Deborah Heart and Lung Center East Orange General Hospital Englewood Hospital and Medical Center Greenville Hospital Hackensack University Medical Center Hackettstown Community Hospital Holy Name Hospital Hunterdon Medical Center Irvington General Hospital Jersey City Medical Center Jersey Shore University Medical Center JFK Community Medical Center-Edison Kennedy Memorial Hospitals UMC-Cherry Hill
15,123 202 149 63 184 235 11 212 120 138 64 90 211 160 157 183 121 618 238 9 136 225 79 583 49 257 119 89 109 322 335 105
1,881 43 22 2 15 26 0 33 16 17 7 6 23 19 18 23 4 98 41 1 13 32 12 58 2 42 10 4 15 44 32 20
12.1 15.0 12.2 5.1 10.1 12.2 6.5 16.6 8.6 11.2 11.5 7.1 11.3 12.5 11.1 9.5 7.4 15.8 14.3 12.7 9.9 13.8 17.0 10.3 7.2 15.6 6.9 9.7 11.6 13.5 8.3 17.3
14,820 181 155 45 167 203 13 197 125 129 58 78 202 153 171 217 123 644 263 1 157 246 56 492 54 211 116 91 125 310 416 83
1,758 37 16 0 22 18 2 17 20 7 1 7 27 19 23 20 7 96 46 0 11 36 4 56 6 25 3 7 30 38 27 10
11.2 14.0 9.6 2.5 13.3 10.0 20.8 10.7 11.9 6.5 5.0 7.3 11.3 7.6 13.8 7.0 9.5 14.1 13.8 . 8.7 13.0 11.2 9.9 11.3 8.8 5.8 11.5 16.8 12.2 7.3 10.9
14,411 157 151 38 170 198 8 189 127 118 44 83 189 189 136 252 115 610 283 6 145 237 62 486 60 229 120 87 123 308 326 77
1,652 32 13 5 16 24 0 14 16 6 1 3 14 17 13 35 9 71 51 0 12 31 5 51 8 27 10 9 28 41 37 8
10.1 11.8 8.0 10.0 10.3 10.3 0.0 8.8 8.6 7.4 4.8 5.0 7.3 9.0 9.9 10.9 9.5 9.7 13.7 0.0 10.2 11.5 8.8 9.1 17.1 9.8 8.4 9.2 16.7 10.8 9.5 6.4
14,381 175 164 40 174 189 14 143 90 115 46 77 170 173 148 237 119 579 282 7 134 256 52 52 480 62 84 73 148 301 386 85
1,628 39 17 1 21 20 4 17 10 9 7 6 19 15 17 22 14 77 38 0 8 32 2 44 7 38 6 5 19 18 34 7
10.0 11.4 8.3 4.9 10.8 10.6 22.5 12.6 7.2 9.8 12.5 9.3 11.1 8.6 10.7 7.1 10.1 10.7 10.6 0.0 8.2 11.2 7.5 8.9 14.8 12.9 7.1 6.9 10.6 6.3 7.1 7.6
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Table 5. Risk-Adjusted Acute Stroke Mortality (per 100) in New Jersey Hospitals, 2002-2005
2002
Hospital Name
National (National Healthcare Quality Report) National (AHRQ Documentation)
2003
Rate
NA 11.0
2004
Rate
11.0 10.6
2005
Rate
10.5 NA
Volume
Deaths
Volume
Deaths
Volume
Deaths
Volume Deaths
Rate
NA NA
Statewide Kennedy Memorial Hospitals UMC-Stratford Kennedy Memorial Hospitals UMC-Wash. Twp. Kimball Medical Center Lourdes Medical Center of Burlington Cty. Meadowlands Hospital Medical Center Memorial Hospital of Salem County Monmouth Medical Center Morristown Memmorial Hospital Mountainside Hospital Muhlenberg Regional Medical Center Newark Beth Israel Medical Center Newton Memorial Hospital Ocean Medical Center Our Lady of Lourdes Medical Center Overlook Hospital Palisades Medical Center of New York Pascack Valley Hospital PBI Regional Medical Center Raritan Bay Medical Center-Old Bridge Raritan Bay Medical Center-Perth Amboy Riverview Medical Center RWJ University Hospital RWJ University Hospital at Hamilton RWJ University Hospital at Rahway Shore Memorial Hospital Somerset Medical Center South Jersey Healthcare Regional MC South Jersey Hospital-Bridgeton South Jersey Hospital-Elmer South Jersey Hospital-Newcomb Southern Ocean County Hospital
15,123 124 124 206 133 78 96 138 325 246 211 241 131 296 233 350 106 176 286 136 169 250 226 344 170 191 259 . 91 64 156 143
1,881 15 12 22 24 8 11 12 50 33 34 29 17 37 21 44 11 17 34 12 24 33 25 40 22 22 37 . 9 6 17 20
12.1 11.4 12.3 12.7 18.0 11.1 10.4 8.5 14.3 10.8 14.8 11.0 13.5 10.7 13.1 11.1 9.8 11.6 10.4 8.7 13.3 11.6 10.5 8.5 9.7 11.5 14.3 . 13.8 11.5 11.7 16.0
14,820 96 125 168 171 52 76 171 255 215 205 196 111 351 264 329 120 149 275 144 160 243 360 214 204 213 332 . 93 46 167 163
1,758 9 18 24 19 3 8 9 50 26 25 25 13 42 26 52 11 28 21 8 29 28 39 16 30 34 30 . 12 4 20 21
11.2 10.8 16.0 14.1 12.4 8.8 9.9 5.6 15.4 9.7 10.6 12.4 11.9 11.3 10.9 13.9 11.4 16.4 8.5 6.4 15.4 10.0 7.8 8.6 13.1 16.2 9.8 . 15.3 8.1 14.7 14.6
14,411 111 142 174 131 60 86 132 244 181 200 201 110 274 240 291 99 134 233 121 151 271 362 224 169 218 290 88 55 56 104 157
1,652 7 14 22 13 3 6 7 43 20 17 27 10 39 15 53 9 15 27 12 17 29 54 20 15 33 30 7 5 9 8 22
10.1 8.4 12.3 11.4 11.2 6.8 7.5 5.7 12.9 8.9 8.4 10.3 9.8 10.4 7.0 11.6 9.0 9.9 9.6 8.9 10.2 9.0 9.1 8.9 6.2 10.7 9.6 9.4 9.6 17.5 9.7 12.9
14,381 95 150 181 133 37 79 152 241 228 161 181 98 278 242 356 70 155 233 109 165 220 429 223 182 240 288 239 0 70 . 153
1,628 3 9 19 15 6 4 6 33 17 13 27 6 44 24 55 14 20 34 6 13 28 68 18 16 25 43 29 . 13 . 20
10.0 4.4 8.1 11.7 16.4 13.7 4.6 3.9 12.3 6.4 6.6 13.1 6.6 11.4 10.6 10.9 13.2 11.8 12.9 4.6 6.8 8.6 9.9 7.5 6.9 11.4 11.2 12.3 . 19.9 . 11.6
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Table 5. Risk-Adjusted Acute Stroke Mortality (per 100) in New Jersey Hospitals, 2002-2005
2002
Hospital Name
National (National Healthcare Quality Report) National (AHRQ Documentation)
2003
Rate
NA 11.0
2004
Rate
11.0 10.6
2005
Rate
10.5 NA
Volume
Deaths
Volume
Deaths
Volume
Deaths
Volume Deaths
Rate
NA NA
Statewide St. Barnabas Medical Center St. Clare's Hospital-Denville St. Clare's Hospital-Dover St. Clare's Hospital-Sussex St. Francis Medical Center-Trenton St. Joseph's Hospital and Medical Center St. Joseph's Wayne Hospital St. Mary Hospital (Hoboken) St. Mary's Hospital (Passaic) St. Peter's University Hospital Trinitas Hospital UMDNJ-University Hospital University Medical Center at Princeton Underwood-Memorial Hospital Union Hospital Valley Hospital Virtua-Memorial Hospital Burlington Cty. Virtua-West Jersey Hospital Berlin Virtua-West Jersey Hospital Marlton Virtua-West Jersey Hospital Voorhees Warren Hospital William B. Kessler Memorial Hospital
15,123 337 286 4 . 131 270 117 105 52 205 38 49 169 200 195 376 263 69 167 192 111 50
1,881 42 47 0 . 11 40 13 17 4 29 38 49 16 19 22 52 23 11 17 17 10 3
12.1 13.9 17.9 8.9 . 6.8 12.1 12.3 12.9 11.7 13.7 15.3 11.1 12.0 12.5 11.5 12.2 10.6 15.5 12.2 11.0 10.3 11.3
14,820 326 261 1 24 122 291 143 135 26 181 189 312 189 150 208 328 257 83 148 174 82 40
1,758 31 38 0 2 12 51 11 13 7 21 31 63 15 8 28 34 27 7 19 15 4 3
11.2 9.6 12.3 . 14.7 8.0 14.1 8.5 9.5 22.6 8.3 14.0 12.8 9.7 10.0 11.7 10.7 12.5 12.9 14.7 11.5 6.6 12.2
14,411 296 272 . 17 117 290 135 114 55 175 218 377 188 175 191 341 293 73 149 151 98 47
1,652 23 29 . 4 7 48 8 12 2 17 35 72 22 15 23 41 25 4 17 9 16 6
10.1 7.6 9.3 . 16.8 5.4 12.1 8.5 8.8 6.0 7.0 12.5 12.4 11.2 11.6 10.4 9.3 10.9 11.9 15.3 9.5 12.9 13.2
14,381 345 214 43 25 88 310 128 101 52 192 197 432 186 179 153 369 265 57 122 148 87 53
1,628 36 28 4 6 7 45 4 19 2 27 27 68 17 8 18 48 15 5 13 12 8 8
10.0 8.9 12.5 7.2 28.3 8.3 12.2 5.1 14.3 5.1 11.2 13.1 10.5 10.7 7.9 10.5 10.7 7.2 9.8 12.8 9.8 9.5 13.7
Notes: 1. Source: New Jersey Uniform Billing Database, 2002 - 2005. 2. Volume reflects all discharges with a principal diagnosis code of acute stroke as given in Table 1. 3. Deaths represent number of in-hospital deaths with a principal diagnosis code of acute stroke. 4. Missing (.) indicates that the hospital did not perform the procedure during the year. 5. AHRQ cautions that rates computed from volumes (denominators) of less than 30 should be interprated with caution.
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Discussion
The 2005 UB data suggest that stroke affects all adults with the elderly (65+ years old) accounting for most (72.3%) of hospitalized patients in 2005. Consistent with the distribution of the stroke patients by age, 64.5% were Medicare insurance carriers with private insurance accounting for (22.2%). The UB data also suggest marked differences in stroke mortality by race/ethnicity of patients. Risk-adjusted stroke mortality declined by 17.4% in 2005 down from 12.1% in 2002. While this decline is good news for New Jersey residents, stroke still remains a major health hazard in the state that needs significant attention by policy makers, healthcare providers as well as the public. This report only provides baseline information that may serve as background for the planned stroke registry in New Jersey. The stroke registry, which is scheduled to start collecting data on January 1, 2009, will provide comprehensive clinical information that the Department will use for outcomes evaluation. The stroke registry will allow for a systematic study of stroke-related patient characteristics such as demographic information, clinical conditions, Joint Commission indicators, and other items to assess outcomes. Once the data collection initiative begins, summary statistics will be made available to participating hospitals on a quarterly basis. An annual report will also be available after the data are reviewed extensively.
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References
CDC, 2007; Public Health and Aging: Hospitalizations for Stroke Among Adults Aged ≥ 65 Years --- United States, 2000; MMWR Weekly June 27 2003, 52(25); 586-589. Agency for Healthcare Research and Quality, 2002, Inpatient Quality Indicators: Software Documentation, Version 2.1 - SAS. Rockville, MD: Revision 3 (July 21, 2004). AHRQ Pub. #02-R0205. AHRQ Inpatient Quality Indicators: Software Documentation: http://www.qualityindicators.ahrq.gov/iqi_archive.htm Health Care Quality Assessment; Inpatient Quality Indicators: New Jersey 2005; A report using 2005 UB data; Health Care Quality Assessment, Office of the Commissioner, Department of Health and Senior Services; August 2007. Health Care Quality Assessment; Inpatient Quality Indicators: Application of the AHRQ Module to New Jersey Data; A report using 2003 UB data; Health Care Quality Assessment, Office of the Commissioner, Department of Health and Senior Services; June 2006. New Jersey Department of Health and Senior Services: http://www.nj.gov/health/healthcarequality/qi.shtml. Utah Department of Health, http://www.hearthighway.org/stroke.html.
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