Abstract P306: The Association of Discharge Disposition With 30-Day Readmission After Ischemic Stroke

Abstract

Objective: Readmission after ischemic stroke presents immense social and financial burden on patients, families and society at large. Post-stroke follow-up, a way to prevent readmission, has generally been focused on patients discharged to home with limited attention to those discharged to other facilities. This study aimed to examine 30-day readmission likelihood among patients of different discharge disposition. Methods: We studied patients who were hospitalized for ischemic stroke in states of Wisconsin, Iowa, Arkansas, and New York in 2016-2017 using the Healthcare Cost and Utilization Project State Inpatient Database. Generalized estimating equation was used to study the association of discharge disposition with 30-day all-cause readmission, after adjusting for patient sociodemographics, 23 comorbidities, hospital characteristics, in-hospital complications, and proxies for stroke severity, accounting for in-hospital clustering. Results: Among 52,301 patients hospitalized for ischemic stroke, 45% were discharged to home without home-health-care, 19% to home with home-health-care, 33.5% to rehabilitation and skilled nursing facilities, 1.5% to short-term hospital, and 0.93% left against medical advice. Patients discharged to home accounted for 34.7% of total 30-day readmissions while discharged to rehabilitation and skilled nursing facilities accounted for 40.6% of total 30-day readmissions. Compared to the patients discharged to home without home-health-care which had the lowest 30-day all-cause readmission rate (8.4%), patients with other dispositions were at higher likelihood of readmission: home with home-health-care (11.3%, adjusted odds ratio [OR], 1.18; 95% confidence interval [CI], 1.08-1.28); rehabilitation and skilled nursing facilities (13.2%; adjusted OR, 1.33; 95% CI, 1.22-1.46); short-term hospitals (23.7%; adjusted OR, 3.09; 95% CI, 2.44-3.93); and left against medical advice (18.6%; adjusted OR, 2.2; 95% CI, 1.75-2.83). Conclusion: Patients who are discharged to rehabilitation and skilled nursing facilities after ischemic stroke are at high likelihood of 30-day readmission and should be a focus of discharge planning to prevent events that lead to readmission.