Predictors of Hospital Readmission After Stroke

Lichtman, Judith H.; Leifheit-Limson, Erica C; Jones, Steve; Watanabe, Emi; Bernheim, Susannah M.; Phipps, Michael; Bhat, Kanchana; Savage, Shantal V.; Goldstein, Larry B.

doi:10.1161/strokeaha.110.599159

Cited by 132 publications

(137 citation statements)

References 20 publications

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“…Previously reported estimates for 30-day readmission rates in patients with stroke have varied from 6.5% to 24.3%, depending on the study methods used to ascertain readmissions. 9 Another recent study reported risk-standardized readmission rates for patients with ischemic stroke, ranging from 9.2% to 19.2% for hospitals with Joint Commission-certified primary stroke centers and 8.8% to 18.4% for hospitals without primary stroke Elective procedures should be coordinated during the index hospitalization or beyond 30 days of discharge. Outpatient clinic appointments should be scheduled prior to discharging the patient, especially among patients who have no primary care physician; consider scheduling outpatient follow-up appointments within 10 days of discharge.…”

Section: Discussionmentioning

confidence: 99%

Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease

Nahab

Takesaka

Mailyan

et al. 2011

The Neurohospitalist

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Background: There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease. Methods: University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases. Results: Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week. Conclusions: More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease.

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Section: Discussionmentioning

confidence: 99%

Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease

Nahab

Takesaka

Mailyan

et al. 2011

The Neurohospitalist

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“…3,4 Readmissions within 1 month of discharge may reflect unresolved problems at discharge, 5 the quality of immediate posthospital care, a more chronically ill population, or because of a combination of these factors. 6 A study in the United States provided evidence that patients with acute stroke who were readmitted within 30 days had a worse chance of survival and incurred greater healthcare costs than patients who were not readmitted. 7 Preventing avoidable readmissions may reduce costs to the healthcare system.…”

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confidence: 99%

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

Kilkenny

Longworth

Pollack

et al. 2013

Stroke

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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.)

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“…[10][11][12][13] In 2008, the Centers for Medicare & Medicaid Services (CMS) began publicly reporting hospitallevel risk-standardized 30-day mortality and readmission rates for these conditions. [14][15][16][17][18] Although similar measures are not currently available for stroke, 19 such measures are planned. High risk-standardized mortality rates (RSMRs) and risk-standardized readmission rates (RSRRs) may indicate poorer quality of care, unresolved problems at initial discharge, the quality of immediate posthospital care, a more chronically ill population, or combinations of these factors.…”

mentioning

confidence: 99%