Why do ischemic stroke and transient ischemic attack patients get readmitted?

Bhattacharya, Pratik; Khanal, Deependra; Madhavan, Ramesh

doi:10.1016/j.jns.2011.05.022

Cited by 36 publications

(52 citation statements)

References 26 publications

(34 reference statements)

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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: 84%

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: 84%

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

Han¹,

Bushnell

2016

J Neurol Neurosci

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“…Patients with stroke are readmitted for cerebrovascular, cardiac, and noncardiac conditions such as urinary tract infection, pneumonia, and hip fracture. 8,38,39 Selected Transitional Care Strategies…”

Section: Risk Of Readmission and Adverse Eventsmentioning

confidence: 99%

Transitional Care Strategies From Hospital to Home

Rennke

Ranji

2014

The Neurohospitalist

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Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a ''bridging'' strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care.

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“…Readmission can be an important outcome of the quality of hospital care for patients with stroke. 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.…”

mentioning

confidence: 99%

“…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). [3][4][5][8][9][10][11][12][13][14][15] Common data sources used to calculate hospital readmissions rates include Medicare data, registry data, patient interviews, or medical records. Evidence from these studies show that the frequency of hospital readmissions may vary from 6.5% to ≈24.3%.…”

mentioning

confidence: 99%

“…Evidence from these studies show that the frequency of hospital readmissions may vary from 6.5% to ≈24.3%. [3][4][5][8][9][10][11][12][13][14][15] 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 or process, and health outcome ( Figure 1). A recent systematic review and other subsequent studies investigating factors associated with readmission after stroke have focused on <30 factors, which fall mainly within patient or health system categories (Table 1).…”

mentioning

confidence: 99%

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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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Why do ischemic stroke and transient ischemic attack patients get readmitted?

Cited by 36 publications

References 26 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

Transitional Care Strategies From Hospital to Home

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

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