How does geographic access affect in-hospital mortality for veterans with acute ischemic stroke?

Ripley DC1, Kwong PL, Vogel WB, Kurichi JE, Bates BE, Davenport C.

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Abstract

OBJECTIVE:

To examine the relationship between estimated travel time to admitting hospital and mortality for veterans with acute ischemicstroke, controlling for patient demographic, clinical, facility-level variables, as well as select in-hospital treatments and procedures.

METHODS:

A longitudinal observational population-based study. Information on all veterans discharged from a Veterans Administration Medical Center (VAMC) with an ischemic stroke diagnosis between October 1, 2006 and September 30, 2008 were examined. A total of 10,430 patients met the inclusion criteria for the study. Unadjusted differences between patients who died during the hospital stay versus those patients who were discharged alive, used χ analyses or Student t tests, as appropriate. Multivariable logistic regression was used to control for confounding effects of patient, treatment, and facility characteristics to examine the relationship between travel time and the bivariate outcome of in-hospital mortality.

RESULTS:

Travel time to the admitting VAMC, our primary variable of interest regarding the effect on in-hospital mortality, after adjusting for the patient, treatment, and facility characteristics showed that longer travel times significantly increased the odds of in-hospital mortality. Travel times ≥ 90 minutes had increased odds of in-hospital mortality (OR=1.476; 95% CI, 1.067-2.042) as compared with <30 minutes.

CONCLUSIONS:

Even after adjusting for the confounding effects of patient, treatment, and facility characteristics, travel time from home to admitting VAMC was significantly associated with in-hospital mortality.