Previous studies have compared cardiovascular disease outcomes between Canada and the United States; however, there are limited data for stroke. This thesis compares hospital discharge data to compare mortality and readmission rates after stroke between Michigan and Ontario. Eligible acute stroke patients (both ischemic and hemorrhagic) were hospitalized between January 1, 2010 and December 31, 2012. A total of 47,364 and 35,648 patients were included in Michigan and Ontario, respectively. To ensure comparability of patient risk profiles between Michigan and Ontario, we applied a Michigan risk-adjustment model to Ontario patients to generate directly standardized outcome rates for Ontario. Results indicate that Ontario stroke patient population was older (mean age: 72.4 vs. 69.5 years), had longer hospital length of stay (mean length of stay: 12.5 vs. 5.4 days), and experienced higher frequencies of acute ischemic heart disease and cancer, whereas the Michigan stroke patient population exhibited higher frequencies of chronic ischemic heart disease, diabetes, heart failure, and renal failure. Ontario had a higher risk-standardized in-hospital mortality rate (13.3%) compared to Michigan (7.6%); however, risk-standardized 30-day readmission rates were similar (5.3% vs. 4.5%). Other performance metrics, such as 30-day mortality, are required to make valid comparisons regarding mortality, but was not possible with the datasets used in this study.
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