The Price of Bouncing Back: One‐Year Mortality and Payments for Acute Stroke Patients with 30‐Day Bounce‐Backs

Kind, Amy; Smith, Maureen A.; Liou, Jinn-Ing; Pandhi, Nancy; Frytak, Jennifer R.; Finch, Michael

doi:10.1111/j.1532-5415.2008.01693.x

Cited by 49 publications

(45 citation statements)

References 36 publications

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“…The readmission rate in our study was comparable to what has been reported using Medicare data (12-14%) or single center studies (10%) [11]. 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].…”

Section: Journal Of Neurology and Neuroscience Issn 2171-6625supporting

confidence: 75%

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

Han¹,

Bushnell

2016

J Neurol Neurosci

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Purpose: In stroke patients, a group at high risk for readmission, there is limited information on medication persistence and its impact on readmission. Utilizing data from a quality improvement program for post-acute processes of care, we investigated the relationship between secondary prevention medication persistence and risk for 90-day readmission in acute stroke patients. Methods:Patients were eligible for the study if they were age 18 years or older and hospitalized with a primary diagnosis of acute ischemic or hemorrhagic stroke, or transient ischemic attack (TIA). A total of 142 patients who had been enrolled in the Transition Coaching for Stroke (TRACS) program were included in the analysis. Results:The mean age was 63.6 ± 13.13 years and 52.8% were women. History of a prior stroke was significantly associated with medication non-persistence (p=0.013, odds ratio [OR], 4.85; 95% confidence interval [CI] 1.39-16.96). History of a prior stroke was also significantly associated with readmission for recurrent stroke or TIA within 30 days of discharge (p= 0.029, OR 7.00; 95% CI 1. 22-40.23). Logistic regression modeling with stroke/TIA readmission at 90 days showed that only prior stroke was significant (p= 0.012, OR 5.54; 95% CI 1.45-21.10). A trend toward lower medication persistence was observed in patients readmitted with a stroke/TIA within 90 days (60.0% vs. 81.8%, p=0.095). Conclusions:In patients discharged with stroke, history of a prior stroke was significantly associated with stroke/TIA readmission at 30 and 90 days after discharge. Poor secondary prevention medication persistence may be a potential risk factor for stroke/TIA readmission. Quality improvement programs focused on improving medication persistence may be essential, especially in patients with a history of recurrent strokes.

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Section: Journal Of Neurology and Neuroscience Issn 2171-6625supporting

confidence: 75%

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

Han¹,

Bushnell

2016

J Neurol Neurosci

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“…This same study found that age, African American race, and chronic disease were also significant predictors of readmission, though these were not predictors in our study. 4 We found that index length of stay greater than 10 days was the only factor associated with 30-day readmission in the multivariable analysis. As has been suggested previously, the length of stay may be a representation of disease severity with greater disease severity associated with longer index hospitalizations.…”

Section: Discussionmentioning

confidence: 75%

“…4,5 One study of patients with acute ischemic stroke found increased rates of ''complicated transition,'' defined as movement from a less intensive to a more intensive level of care including rehospitalization and return visits to the emergency department, in patients with increased length of stay. This same study found that age, African American race, and chronic disease were also significant predictors of readmission, though these were not predictors in our study.…”

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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“…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. 8 Several studies have been undertaken to examine the frequency of readmissions within 1 month of discharge after stroke, mainly from the United States, Australia, Denmark, and Taiwan (Table 1).…”

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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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The Price of Bouncing Back: One‐Year Mortality and Payments for Acute Stroke Patients with 30‐Day Bounce‐Backs

Abstract: Background-"Bounce-backs" (movements from less intensive to more intensive care settings) soon after hospital discharge for acute stroke are common, but the long-term costs and mortality consequences associated with bouncing-back remain unknown.

Cited by 49 publications

References 36 publications

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

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

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

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

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