Association between comprehensive geriatric assessment and short-term outcomes among older adult patients with stroke: A nationwide retrospective cohort study using propensity score and instrumental variable methods.
Background: Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary method to identify geriatric conditions among older patients. The aim of the present study was to examine the associations between CGA and short-term outcomes among older adult inpatients with stroke.
Methods: The study was a nationwide, retrospective cohort study. We used the Diagnosis Procedure Combination database, a national Japanese inpatient database, to identify older adult stroke patients from 2014 to 2017. The associations between CGA and in-hospital mortality, length of hospital stay, readmission rate, rehabilitation intervention, and introduction of home health care were evaluated using propensity score matching and instrumental variable analysis.
Findings: We identified 338,720 patients, 21.3% of whom received CGA. A propensity score-matched analysis of 53,861 pairs showed that in-hospital mortality was significantly lower in the CGA group than in the non-CGA group (3.6% vs. 4.1%, p < 0.001). The rate of long-term hospitalization (> 60 days) was significantly lower in the CGA group than in the non-CGA group (8.7% vs. 10.1%, p < 0.001), and the rates of rehabilitation intervention (30.3% vs. 24.9%, p < 0.001) and home health care (8.3% vs. 7.6%, p = 0.001) were both higher in the CGA group than in the non-CGA group. Instrumental variable analysis showed similar results.
Interpretation: CGA was significantly associated with the examined short-term outcomes. These findings from Japan, one of the most aged countries worldwide, highlight the possible benefits of CGA for short-term outcomes and can be of use for health policy in other international contexts.
Funding: This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141).
|投稿者||Hosoi, Tatsuya; Yamana, Hayato; Tamiya, Hiroyuki; Matsui, Hiroki; Fushimi, Kiyohide; Akishita, Masahiro; Yasunaga, Hideo; Ogawa, Sumito|
|組織名||Department of Geriatric Medicine, Graduate School of Medicine, The University of;Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.;Department of Health Services Research, Graduate School of Medicine, The;University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.;Department of Clinical Epidemiology and Health Economics, School of Public;Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.|