Michelle H Leppert1, Stefan Sillau2, Richard C Lindrooth2, Sharon N Poisson2, Jonathan D Campbell2, Jennifer R Simpson2. 1. From the Department of Neurology (M.H.L., S.S., S.N.P., J.R.S.), University of Colorado School of Medicine, Aurora; Colorado Cardiovascular Outcomes Research Group (M.H.L.), Denver; and Colorado School of Public Health (R.C.L.) and Skagg School of Pharmacy and Pharmaceutical Sciences (J.D.C.), University of Colorado Anschutz Medical Campus, Aurora. michelle.leppert@ucdenver.edu. 2. From the Department of Neurology (M.H.L., S.S., S.N.P., J.R.S.), University of Colorado School of Medicine, Aurora; Colorado Cardiovascular Outcomes Research Group (M.H.L.), Denver; and Colorado School of Public Health (R.C.L.) and Skagg School of Pharmacy and Pharmaceutical Sciences (J.D.C.), University of Colorado Anschutz Medical Campus, Aurora.
Abstract
OBJECTIVE: To examine whether early follow-up with primary care or neurology is associated with lower all-cause readmissions within 30 and 90 days after acute ischemic stroke admission. METHODS: We performed a retrospective cohort study of patients who were discharged home after acute ischemic stroke, identified by ICD-9 and ICD-10 codes, using PharMetrics, a nationally representative claims database of insured Americans from 2009 to 2015. The primary predictor was outpatient primary care or neurology follow-up within 30 and 90 days of discharge, and the primary outcome was all-cause 30- and 90-day readmissions. Multivariable Cox models were used with primary care and neurology visits specified as time-dependent covariates, with adjustment for patient demographics, comorbid conditions, and stroke severity measures. RESULTS: The cohort included 14,630 patients. Readmissions within 30 days occurred in 7.3% of patients, and readmissions within 90 days occurred in 13.7% of patients. By 30 days, 59.3% had a primary care visit, and 24.4% had a neurology visit. Primary care follow-up was associated with reduced 30-day readmissions (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.72-0.98). Primary care follow-up before 90 days did not reach significance (HR 0.92, 95% CI 0.83-1.03). Neurology follow-up was not associated with reduced readmissions within 30 or 90 days (HR 1.05, 95% CI; HR 1.00, 95% CI, respectively). CONCLUSION: Early outpatient follow-up with primary care is associated with a reduction in 30-day hospital readmissions. Early outpatient follow-up may represent an important opportunity for intervention after acute stroke admissions.
OBJECTIVE: To examine whether early follow-up with primary care or neurology is associated with lower all-cause readmissions within 30 and 90 days after acute ischemic stroke admission. METHODS: We performed a retrospective cohort study of patients who were discharged home after acute ischemic stroke, identified by ICD-9 and ICD-10 codes, using PharMetrics, a nationally representative claims database of insured Americans from 2009 to 2015. The primary predictor was outpatient primary care or neurology follow-up within 30 and 90 days of discharge, and the primary outcome was all-cause 30- and 90-day readmissions. Multivariable Cox models were used with primary care and neurology visits specified as time-dependent covariates, with adjustment for patient demographics, comorbid conditions, and stroke severity measures. RESULTS: The cohort included 14,630 patients. Readmissions within 30 days occurred in 7.3% of patients, and readmissions within 90 days occurred in 13.7% of patients. By 30 days, 59.3% had a primary care visit, and 24.4% had a neurology visit. Primary care follow-up was associated with reduced 30-day readmissions (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.72-0.98). Primary care follow-up before 90 days did not reach significance (HR 0.92, 95% CI 0.83-1.03). Neurology follow-up was not associated with reduced readmissions within 30 or 90 days (HR 1.05, 95% CI; HR 1.00, 95% CI, respectively). CONCLUSION: Early outpatient follow-up with primary care is associated with a reduction in 30-day hospital readmissions. Early outpatient follow-up may represent an important opportunity for intervention after acute stroke admissions.
Authors: Judith H Lichtman; Erica C Leifheit-Limson; Sara B Jones; Emi Watanabe; Susannah M Bernheim; Michael S Phipps; Kanchana R Bhat; Shantal V Savage; Larry B Goldstein Journal: Stroke Date: 2010-10-07 Impact factor: 7.914
Authors: Carolee J Winstein; Joel Stein; Ross Arena; Barbara Bates; Leora R Cherney; Steven C Cramer; Frank Deruyter; Janice J Eng; Beth Fisher; Richard L Harvey; Catherine E Lang; Marilyn MacKay-Lyons; Kenneth J Ottenbacher; Sue Pugh; Mathew J Reeves; Lorie G Richards; William Stiers; Richard D Zorowitz Journal: Stroke Date: 2016-05-04 Impact factor: 7.914
Authors: Piyameth Dilokthornsakul; Robert J Valuck; Kavita V Nair; John R Corboy; Richard R Allen; Jonathan D Campbell Journal: Neurology Date: 2016-02-17 Impact factor: 9.910
Authors: Linda Kalilani; Edward Faught; Hyunmi Kim; Chakkarin Burudpakdee; Arpamas Seetasith; Scott Laranjo; David Friesen; Kathrin Haeffs; Victor Kiri; David J Thurman Journal: Neurology Date: 2019-04-10 Impact factor: 9.910
Authors: Narayanaswamy Venketasubramanian; Craig Anderson; Hakan Ay; Selma Aybek; Waleed Brinjikji; Gabriel R de Freitas; Oscar H Del Brutto; Klaus Fassbender; Miki Fujimura; Larry B Goldstein; Roman L Haberl; Graeme J Hankey; Wolf-Dieter Heiss; Isabel Lestro Henriques; Carlos S Kase; Jong S Kim; Masatoshi Koga; Yoshihiro Kokubo; Satoshi Kuroda; Kiwon Lee; Tsong-Hai Lee; David S Liebeskind; Gregory Y H Lip; Stephen Meairs; Roman Medvedev; Man Mohan Mehndiratta; Jay P Mohr; Masao Nagayama; Leonardo Pantoni; Panagiotis Papanagiotou; Guillermo Parrilla; Daniele Pastori; Sarah T Pendlebury; Luther Creed Pettigrew; Pushpendra N Renjen; Tatjana Rundek; Ulf Schminke; Yukito Shinohara; Wai Kwong Tang; Kazunori Toyoda; Katja E Wartenberg; Mohammad Wasay; Michael G Hennerici Journal: Cerebrovasc Dis Date: 2021-03-23 Impact factor: 2.762
Authors: Shilpa Tyagi; Gerald Choon-Huat Koh; Nan Luo; Kelvin Bryan Tan; Helen Hoenig; David B Matchar; Joanne Yoong; Angelique Chan; Kim En Lee; N Venketasubramanian; Edward Menon; Kin Ming Chan; Deidre Anne De Silva; Philip Yap; Boon Yeow Tan; Effie Chew; Sherry H Young; Yee Sien Ng; Tian Ming Tu; Yan Hoon Ang; Keng He Kong; Rajinder Singh; Reshma A Merchant; Hui Meng Chang; Tseng Tsai Yeo; Chou Ning; Angela Cheong; Yu Li Ng; Chuen Seng Tan Journal: BMC Fam Pract Date: 2021-04-14 Impact factor: 2.497