James F Burke1, Lesli E Skolarus2, Eric E Adelman2, Mathew J Reeves2, Devin L Brown2. 1. From the Department of Veterans Affairs (J.F.B.), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, MI; Stroke Program (J.F.B., L.E.S., E.E.A., D.L.B.), University of Michigan, Ann Arbor; and Department of Epidemiology (M.J.R.), Michigan State University, East Lansing. jamesbur@umich.edu. 2. From the Department of Veterans Affairs (J.F.B.), VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, MI; Stroke Program (J.F.B., L.E.S., E.E.A., D.L.B.), University of Michigan, Ann Arbor; and Department of Epidemiology (M.J.R.), Michigan State University, East Lansing.
Abstract
OBJECTIVE: To inform stroke quality improvement initiatives by determining the relationship between hospital-level stroke practices and readmission after accounting for patient-level factors. METHODS: Retrospective cohort study of adult patients hospitalized for ischemic stroke (principal ICD-9-CM codes 433.x1, 434.x1, and 436) in 5 states from 2003 to 2009 from State Inpatient Databases. The primary outcome was any unplanned readmission within 30 days. Multilevel logistic regression was used to estimate the association between hospital-level practice patterns of care (diagnostic testing, procedures, intensive care unit, tissue plasminogen activator, and therapeutic modalities) and readmission after adjustment for patient factors and whether individual patients received a given practice. RESULTS: Thirty-day unplanned readmission occurred in 15.2% of stroke admissions; the median hospital readmission rate was 13.6% (interquartile range 9.8%-18.2%). Of the 25 hospital practice patterns of care analyzed, 3 practices were associated with readmission: hospitals with higher use of occupational therapy and higher proportion of transfers from other hospitals had lower adjusted readmission rates, whereas hospitals with higher use of hospice had higher predicted readmission rates. Readmission rates in lowest vs highest utilizing quintile were as follows: occupational therapy 16.2% (95% confidence interval [CI] 14.5%-18.0%) vs 12.3% (95% CI 11.3%-13.2%); transfers 13.8% (95% CI 13.2%-14.5%) vs 12.5% (95% CI 11.6%-13.5%); and hospice 13.1% (95% CI 12.3%-14.0%) vs 14.8% (95% CI 13.5%-16.1%). CONCLUSIONS: Hospital practices have a role in stroke readmission that is complex and poorly understood. Further work is needed to identify specific strategies to reduce readmission rates and to ensure that public reporting of readmission rates will not result in adverse unintended consequences.
OBJECTIVE: To inform stroke quality improvement initiatives by determining the relationship between hospital-level stroke practices and readmission after accounting for patient-level factors. METHODS: Retrospective cohort study of adult patients hospitalized for ischemic stroke (principal ICD-9-CM codes 433.x1, 434.x1, and 436) in 5 states from 2003 to 2009 from State Inpatient Databases. The primary outcome was any unplanned readmission within 30 days. Multilevel logistic regression was used to estimate the association between hospital-level practice patterns of care (diagnostic testing, procedures, intensive care unit, tissue plasminogen activator, and therapeutic modalities) and readmission after adjustment for patient factors and whether individual patients received a given practice. RESULTS: Thirty-day unplanned readmission occurred in 15.2% of stroke admissions; the median hospital readmission rate was 13.6% (interquartile range 9.8%-18.2%). Of the 25 hospital practice patterns of care analyzed, 3 practices were associated with readmission: hospitals with higher use of occupational therapy and higher proportion of transfers from other hospitals had lower adjusted readmission rates, whereas hospitals with higher use of hospice had higher predicted readmission rates. Readmission rates in lowest vs highest utilizing quintile were as follows: occupational therapy 16.2% (95% confidence interval [CI] 14.5%-18.0%) vs 12.3% (95% CI 11.3%-13.2%); transfers 13.8% (95% CI 13.2%-14.5%) vs 12.5% (95% CI 11.6%-13.5%); and hospice 13.1% (95% CI 12.3%-14.0%) vs 14.8% (95% CI 13.5%-16.1%). CONCLUSIONS: Hospital practices have a role in stroke readmission that is complex and poorly understood. Further work is needed to identify specific strategies to reduce readmission rates and to ensure that public reporting of readmission rates will not result in adverse unintended consequences.
Authors: Peter Langhorne; Gillian Taylor; Gordon Murray; Martin Dennis; Craig Anderson; Erik Bautz-Holter; Paola Dey; Bent Indredavik; Nancy Mayo; Michael Power; Helen Rodgers; Ole Morten Ronning; Anthony Rudd; Nijasri Suwanwela; Lotta Widen-Holmqvist; Charles Wolfe Journal: Lancet Date: 2005 Feb 5-11 Impact factor: 79.321
Authors: Kamakshi Lakshminarayan; Candace Schissel; David C Anderson; Gabriela Vazquez; David R Jacobs; Mustapha Ezzeddine; Russell V Luepker; Beth A Virnig Journal: Stroke Date: 2011-04-07 Impact factor: 7.914
Authors: Kyle R Allen; Susan Hazelett; David Jarjoura; Glenda C Wickstrom; K Hua; J Weinhardt; K Wright Journal: J Stroke Cerebrovasc Dis Date: 2002 Mar-Apr Impact factor: 2.136
Authors: Sidney T Le; S Andrew Josephson; Hans A Puttgen; Lorrie Gibson; Elan L Guterman; Heather M Leicester; Carla L Graf; John C Probasco Journal: Neurohospitalist Date: 2016-10-22
Authors: Michelle H Leppert; Stefan Sillau; Richard C Lindrooth; Sharon N Poisson; Jonathan D Campbell; Jennifer R Simpson Journal: Neurology Date: 2020-02-20 Impact factor: 9.910
Authors: Alexandra Leitão; Anabela Brito; João Pinho; José Nuno Alves; Ricardo Costa; José Manuel Amorim; Manuel Ribeiro; Inês Pinho; Carla Ferreira Journal: Intern Emerg Med Date: 2016-08-06 Impact factor: 3.397
Authors: Nicole Rosendale; Elan L Guterman; John P Betjemann; S Andrew Josephson; Vanja C Douglas Journal: Neurology Date: 2019-05-24 Impact factor: 9.910
Authors: Amit Kumar; Linda Resnik; Amol Karmarkar; Janet Freburger; Deepak Adhikari; Vincent Mor; Pedro Gozalo Journal: Arch Phys Med Rehabil Date: 2019-01-24 Impact factor: 3.966