Patient-reported health-related quality of life as complex patient outcomes in stroke survivors

In the U.S., approximately 700,000 Americans experience a stroke each year, resulting in substantial morbidity and mortality. Multiple domains of health-related quality of life (HRQoL) are affected in stroke survivors, and in an aging America, we are likely to see an increase in stroke because the risk of stroke increases with age. The rising incidence of stroke and persistent disabilities suggests an urgent need to reduce the burden of stroke. The standard measures for patient outcomes after stroke is the modified Rankin Scale (mRS) which heavily focuses on patient mobility and is less discriminating for other domains of HRQoL (e.g., cognitive function, depression, fatigue). However, patients often have complex patient outcomes with varying degrees of abnormal HRQoL across multiple domains, and not much is known about how these HRQoL scores cluster together. Reductions in HRQoL other than mobility remain difficult to predict, limiting patient outcomes assessment and management. To address this need, we will identify complex patient outcomes after stroke that incorporate multiple domains of HRQoL and determine if variables collected during a patient’s index hospitalization enables prediction of an individual’s complex patient outcome at three-month follow-up. The study’s objectives are to assess differentially identified HRQoL domains as the driver of complex patient outcomes and inform target care improvements that meet the needs of unmeasured and under-treated HRQoL domains. To meet the objectives, Aim 1 will determine the HRQoL domains that are not well described by the standard mRS for patient outcomes. Aim 2 will identify complex patient outcomes across multiple domains of HRQoL in patients with the three major types of stroke (AIS, ICH, SAH). Aim 3 will predict complex patient outcomes at follow-up from patient data accumulated during their index hospitalization. We will utilize data from two sources: 1) the Northwestern University Brain Attack Registry