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Study Identifies Risk Factors for Hospital Readmission

Authors evaluate stroke patients

Hospital readmission, an important measure of quality care, costs the U.S. an estimated $17 billion each year. According to the Centers for Medicare and Medicaid Services (CMS), about half of those readmissions could be avoided.

Therefore, there is significant interest in identifying factors that influence readmission rates, especially those that can be identified before discharge.

In a retrospective case-control study, researchers at Wake Forest Baptist Medical Center sought to determine factors associated with readmission within 30 days among stroke patients. Their findings were published in the June 11 online edition of the American Journal of Medical Quality.

“If you can recognize who is at risk, you can really focus on those people to try to make sure they are treated appropriately and followed closely,” said investigator Cheryl Bushnell, MD.

The goal of this single-center study was to identify at the time of discharge the factors that were strongly associated with readmission in patients with ischemic and hemorrhagic stroke. The study compared 79 stroke patients who were readmitted to the hospital within 30 days with 86 controls over an 18-month period. There were no significant differences in age, gender or race/ethnicity between the stroke patients and the controls.

The researchers found that readmitted patients were significantly more likely to have a prior diagnosis of congestive heart failure, coronary artery disease, cancer, or hyperlipidemia. In addition, readmitted patients were more likely to have been hospitalized two or more times during the year before the initial stroke admission.

The findings suggest that the severity of stroke and number of hospitalizations within the year prior to the stroke admission are important predictors of subsequent readmission within 30 days, independent of other clinical factors, Bushnell said.

“If our model is validated in a larger study, it could then be used in electronic health records to provide a potentially reproducible, efficient, and effective means of selecting patients most at risk for subsequent hospital readmission. A logical next step is to develop innovative tools and programs for stroke patients to keep patients from being readmitted,” she said.

A limitation of the study was that the data were collected only at discharge, Bushnell added. She said that subsequent research will include the evaluation of post-discharge data.

Source: Wake Forest Baptist Medical Center; June 11, 2014.

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