Predictors of 30-Day Hospital Readmission Following Ischemic and Hemorrhagic Stroke

Abstract

Stroke patients have a high rate of 30-day readmission. Understanding the characteristics of patients at high risk of readmission is critical. A retrospective case-control study was designed to determine factors associated with 30-day readmission after stroke. A total of 79 cases with acute ischemic or hemorrhagic strokes readmitted to the same hospital within 30 days were compared with 86 frequency-matched controls. Readmitted patients were more likely to have had ≥2 hospitalizations in the year prior to stroke (21.5% vs 2.3% in controls, P < .001), and in the multivariate model, admission National Institutes of Health Stroke Score (NIHSS; odds ratio [OR] = 1.072; 95% confidence interval [CI] = 1.021-1.126 per 1 point increase; P = .005), prior hospitalizations (OR = 2.205; 95% CI = 1.426-3.412 per admission; P < .001), and absence of hyperlipidemia (OR = 0.444; 95% CI = 0.221-0.894; P = .023) were independently associated with readmission. The research team concludes that admission NIHSS and frequent prior hospitalizations are associated with 30-day readmission after stroke. If validated, these characteristics identify high-risk patients and focus efforts to reduce readmission.

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

“…In this study, prior hospitalization was significantly associated with all-cause readmission at 30 days (p= 0.034). Using our own hospital data to determine the risks for readmission in stroke patients discharged to all locations (and not just to home), we found a 2.2-fold higher risk of 30-day readmission with each prior hospitalization before the stroke [13]. The current analysis also confirmed the importance of the prior hospitalization as a predictor of early readmission.…”

“…The available data on stroke patients suggest that medication persistence is often sub-optimal, and that many patients are consequently at a significantly increased risk of a further stroke [6,13,16]. Although early initiation of prevention strategies has shown sustained persistence and good outcomes in some stroke patients, other evidence suggests that use of these secondary prevention therapies may not persist long-term [19].…”

“…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].…”

Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program

“…To determine which patients were at high risk for readmission, an internal retrospective review at our hospital identified risk factors that included acute renal failure during index hospitalization, history of congestive heart failure, and ≥2 visits to emergency department or hospitalizations within the past year. 12 We also included patients who were on anticoagulation, those with multiple barriers to care, or poor social support. These factors were identified during the acute hospitalization by the NP.…”

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.…”