Abstract 87: Factors Affecting Readmission Rates for Patients With Ischemic Stroke Hospitalized in an Integrated Health System of Stroke Care

Abstract

Objective: We looked for factors associated with hospital readmission rates in patients diagnosed with ischemic stroke. Methods: The Stroke Program Quality Initiative developed a MIDAS™ report of all inpatient encounters to all hospitals within an integrated health system within 30 days of a stroke discharge. A focus study guided a detailed case review including demographics, index admission stroke subtype, discharge treatment and disposition, readmission diagnosis, and location. The dependent variable was readmission to the hospital within 30 days. Characteristics were compared between patients that were not readmitted versus patients that were readmitted using odds ratios (OR). Results: The analysis included 1843 stroke discharges from June 2016 to May 2018. The overall 30-day all-cause readmission rate for ischemic stroke patients was 13%; 14% at the comprehensive stroke center and 10 to 16% at the primary stroke centers. The principal diagnoses for readmission were sepsis or infection (14%), recurrent stroke (13%), and cardiovascular events (7.3). During this period, compliance with evidence-based guidelines for inpatient stroke care exceeded benchmarks. Mean time between admissions was 10 days. Of the patients that were readmitted, 30% of the patients were admitted to a different facility than their initial admission. Patients that received either tissue plasminogen activator (tPA) or mechanical thrombectomy seemed to be associated with decreased readmission rates (OR 0.5). Higher readmission rates were associated with length of stay (Overall OR 2.3; individual facilities (IF) ORs 2.1, 1.6, 2.2, 2.3, 3.5), females (Overall OR 1.3; IF ORs 1.3, 1.3, 1.3, 0.68, 0.69), age > 75 (Overall OR 1.5; IF ORs 1.8, 1.6, 1.7, 1.88, 1.7), and patients discharged to a skilled nursing facility (Overall OR 1.3; IF ORs 1.5, 0.94, 1.3, 0.98, 0.57). Widows and divorced patients had an overall OR of 1.5. Conclusion: A combination of demographic and disposition factors can consistently predict higher readmission rates amongst ischemic stroke patients within a large hospital system that shares a cohesive stroke care policy amongst the individual facilities, whereas acute treatments with either tPA or mechanical thrombectomy were protective.