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

• Authors: Fadi Nahab, Emory University; Jennifer Takesaka, Emory University; Eugene Mailyan, Emory University; Lilith M. Judd, Emory University; Steven D Culler, Emory University; Adam C. Webb, Emory University; Michael Frankel, Emory University; Dennis W Choi, Emory University; Sandra Helmers, Emory University
• Journal Title: Neurohospitalist
• Volume: Volume 2, Number 1
• Publisher: SAGE Publications (UK and US) | 2012-01, Pages 7-11
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1177/1941874411427733
• Subjects: Biology, Neuroscience; Health Sciences, Health Care Management
• Keywords: stroke; patient readmission; outcome assessment (health care)

Abstract

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.