Abstract W P277: 30 Day Readmission Rates are Higher at Primary Stroke Centers than at Comprehensive Stroke Centers

Abstract

Objective: To compare readmission rates between The Joint Commission designated Primary and Comprehensive Stroke Centers. Background: The Joint Commission (TJC) designations of Primary Stroke Center (PSC) and Comprehensive Stroke Center (CSC) certification recognize best practices in stroke patient care. TJC introduced the CSC designation to recognize programs that provide a higher level of care than PSCs, including 24-hour MRI, specialized neuro-intensive care units, and 24-hour endovascular treatment. It is unknown whether clinical outcomes, such as readmission rates and length of stay, differ between PSCs and CSCs. Methods: The University HealthSystem Consortium (UHC) is made up of 120 member academic medical centers who share hospital level data. Using UHC’s Clinical Database, we assessed 30 day readmission rates at PSCs and CSCs for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage patients for 2013, along with length of stay (LOS), ICU admission, and overall mortality rate. UHC’s expected mortality rate was derived using an algorithm based on clinical factors including severity of illness, co-morbidities, and patient demographics; this expected mortality rate was used as a measure of patient acuity. Ischemic stroke patients’ 30 day readmission rates, LOS, ICU admission, overall mortality rate, and expected mortality rate were also compared between PSCs and CSCs. Results: There were a total of 54,962 patients admitted to 75 PSCs and 38 CSCs. 30 day readmission rates were 2.70% for PSCs and 2.39% for CSCs (p=0.03). LOS was longer at CSCs than at PSCs (8.07 vs. 7.51 days, p<0.001). PSCs had a lower proportion of ICU cases (43.34% vs 58.57%), a lower mortality rate (9.20% vs. 11.05%), and a lower expected mortality rate than CSCs (p<0.001 for all). When analyzing only ischemic strokes, the 30 day readmission rate remained higher at PSCs (2.65% vs 2.13%, p=0.001) with shorter LOS (5.63 vs. 5.97 days, p<0.001). Conclusion: In our study, CSCs had statistically significant lower 30 day readmission rates than PSCs. However, stroke patients at CSCs had longer hospital stays and required a higher acuity of care. Future research is needed to define aspects of hospital care at designated CSCs that could lead towards reduced readmissions.