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Increasing comorbidity and health services utilization in older adults with prior stroke
Gruneir A, Griffith LE, Fisher K, Panjwani D, Gandhi S, Sheng L, Patterson C, Gafni A et al.. Neurology, 2016-10-19
Topic: Health services, long-term care and technology
Objective To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. Methods This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. Results A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity. Conclusions Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
Key findings
- Results A total of 29,673 individuals met our criteria.
- Conclusions Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
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Study details
- Study designcohort study
- Participants29,673
- Effect size74.9%; 89.8%; 65.8%
- Evidence strengthModerate
How this study scored 71/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 41 of the 58 points we could judge it on, which is 71 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2016 — within 20 year(s) of the newest study here |
| Sample size | 4 / 4 | 29,673 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 27760870) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 41 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 41 of the 58 points we could judge it on is 71 out of 100. |
| Total | 71 / 100 | — |
What each of these 20 components measures, and what this score is not →
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APA 7th
Gruneir, A., Griffith, L. E., Fisher, K., Panjwani, D., Gandhi, S., Sheng, L., et al. (2016). Increasing comorbidity and health services utilization in older adults with prior stroke. Neurology. https://doi.org/10.1212/wnl.0000000000003329
Vancouver
Gruneir A, Griffith LE, Fisher K, Panjwani D, Gandhi S, Sheng L, et al. Increasing comorbidity and health services utilization in older adults with prior stroke. Neurology. 2016. doi:10.1212/wnl.0000000000003329. PMID: 27760870.
BibTeX
@article{gruneir2016-27760870,
author = {Gruneir, A. and Griffith, L. E. and Fisher, K. and Panjwani, D. and Gandhi, S. and Sheng, L. and Patterson, C. and Gafni, A. and others},
title = {{Increasing comorbidity and health services utilization in older adults with prior stroke}},
journal = {Neurology},
year = {2016},
doi = {10.1212/wnl.0000000000003329},
pmid = {27760870},
url = {https://doi.org/10.1212/wnl.0000000000003329}
}