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Abstract Details

Estimates and Temporal Trend for Nationwide 30-day Hospital Readmission Among Patients with Ischemic and Hemorrhagic Stroke: A Contemporary Population Based Analysis of 6-Year Nationwide Data
Cerebrovascular Disease and Interventional Neurology
S47 - Stroke Outcomes and Recurrence (1:11 PM-1:22 PM)
002

Readmission reduction is linked with improved quality of care, saves cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for SPs are unavailable.

 

To provide nationwide estimates and a temporal trend for overall, planned, and potentially-preventable 30-day-readmission among ischemic and hemorrhagic stroke patients (SPs). To determine the association between hospitals’ stroke discharge volume (SDV), teaching status and 30-day-readmission. To highlight the causes of 30-day-readmission.

 

We performed a year-wise cohort analysis of the national readmission database from January 2010 to September 2015. Adult (≥ 18 years) patients with primary discharge diagnosis of ischemic stroke (IS), intracerebral hemorrhage (ICH), or sub-arachnoid hemorrhage (SAH) were tagged using validated ICD-9 codes. Hospitals were categorized by their annual SDV and were classified as teaching if they had an American Medical Association-approved residency program or had a ratio of full-time equivalent interns / residents to beds of 0.25 or higher. We defined readmission as any admission within 30 days of index hospitalization discharge. Using CMS defined algorithms, events were classified as unplanned and/or potentially-preventable.

 

Based on our criteria, 2,078,854 eligible patients were included. Mean (SE) age: 70.02 (0.07), and 51.90% female. The overall proportion (95% CI) for 30-day-readmission was highest for ICH patients (13.70%, 13.40 – 13.99), followed by IS (12.44%, 12.33 – 12.55) and SAH patients (11.48%, 11.01 – 11.96). On average there was a 3.3% annual decline in readmission between 2010 and 2014, which was statistically significant (OR, 95% CI: 0.96, 0.95 – 0.97). Patients discharged from non-Teaching hospitals with high SDV were at a significantly higher risk of 30-day-readmission and the top 2 leading causes of readmission were acute cerebrovascular disease and septicemia.

 

Nationally representative readmission metrics can be used to benchmark hospitals’ performance, and a temporal trend of 3% may be used to evaluate effectiveness of readmission reduction strategies.
Authors/Disclosures
Farhaan S. Vahidy, MBBS, PhD (Houston Methodist)
PRESENTER
Dr. Vahidy has nothing to disclose.
No disclosure on file
John Donnelly No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Louise D. McCullough, MD, PhD (McGovern Medical School, UTHealth) The institution of Dr. McCullough has received research support from NIH. The institution of Dr. McCullough has received research support from American Heart Association.
Sean I. Savitz, MD Dr. Savitz has nothing to disclose.