Factors Associated With 28-Day Hospital Readmission After Stroke in Australia

Abstract

Background and Purpose-Understanding the factors that contribute to early readmission after discharge following stroke is limited. We aimed to describe the factors associated with 28-day readmission after hospitalization for stroke. Methods-Factors associated with readmission were classified from the medical record standardized audits of 50 to 100 consecutively admitted patients with stroke from 35 Australian hospitals during multiple time periods (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010).Factors were compared between patients readmitted and not readmitted after stroke hospitalization (n=43) grouped using 5 categories: patient characteristics (n=16; eg, age), clinical processes of care (n=13; eg, admitted into a stroke unit), social circumstances (n=3; eg, living home alone prior), health system (n=6; eg, location of hospital), and health outcome (n=5; eg, length of stay). Multilevel logistic regression modeling was used to examine the association with these independent factors selected if statistical significance P<0.15 or if considered clinically important and readmission status. Results-Among 3328 patients, 6.5% were readmitted within 28 days (mean age, 75; 48% female; 92% ischemic). After bivariate analyses 14/43 factors from 4/5 categories were associated with readmission after hospitalization for stroke. Two factors from patient and health outcome categories remained independently associated with readmission after multivariable analyses. These were dependent premorbid functional status (adjusted odds ratio, 1.87; 95% confidence interval, 1.25-2.81) and having a severe adverse event during the initial hospitalization for stroke (adjusted odds ratio, 2.81; 95% confidence interval, 1.55-5.12). Conclusions-This is the first study to comprehensively evaluate factors associated with 28-day readmission after stroke.The factors associated with 28-day readmission are diverse and include potentially modifiable and nonmodifiable factors. (Stroke. 2013;44:2260-2268.)

Stroke Secondary Medication Persistence and Risk for Hospital Readmission within 90 Days after Discharge

“…Several studies have been undertaken to examine the frequency of readmissions within 30 days of discharge after stroke [13,27]. Evidence from these studies show that the frequency of hospital readmissions may vary from 6.5% to 24.3% [27]. The readmission rate in our study was comparable to what has been reported using Medicare data (12-14%) or single center studies (10%) [11].…”

“…The second important finding from our study is that the frequency of all-cause readmission in this study was 8.5% at 30 days and 18.5% at 90 days after discharge. Several studies have been undertaken to examine the frequency of readmissions within 30 days of discharge after stroke [13,27]. Evidence from these studies show that the frequency of hospital readmissions may vary from 6.5% to 24.3% [27].…”

“…Patients with strokes, who are readmitted within 30 days, are at a higher risk of mortality in the long term and incur greater healthcare costs [10,28]. The potential factors that may be associated with being readmitted after an initial hospitalization for stroke can be grouped into 5 broad categories: patient characteristics, social circumstances, health system, clinical care, and health outcome [27]. In this study, prior hospitalization was significantly associated with all-cause readmission at 30 days (p= 0.034).…”

Impact of Poststroke Medical Complications on 30-Day Readmission Rate

“…6,9 Furthermore, the few hospital-based studies have used different methodologies and have included only limited data on disease severity, hospital course, and outcomes. [10][11][12][13] A recent review of hospital standards for quality reporting of readmissions after stroke concluded that future work should focus on identifying risk factors at the patient level that are not typically or reliably included in administrative data sets. 14 Although identification of predictors for stroke readmission is important, many previously identified factors including age and initial stroke severity are nonmodifiable and thus provide limited opportunity for targeted interventions.…”

Risk predictors for hospital readmission in a low socio-economic and underserved population

“…Past research on the association between smoking status and readmission rates has produced equivocal results. [26][27][28][29][30][31][32][33][34] Many studies have examined commonly collected demographic variables. It has been reported that increasing age could potentially serve as a predictor of all-cause hospital readmissions, especially in patients over the age of 65.…”