Abstract WP306: Race-Ethnic Disparities in 30-Day Readmission After Ischemic Stroke Among Medicare Beneficiaries in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study

Abstract

Background: 30-day readmission after ischemic stroke is an important health quality of care metric, but little is known about potential race-ethnic disparities for this outcome. We examined 30-day rates and causes for readmission among Medicare beneficiaries in the NINDS-funded Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (CReSD) Study. Methods: We examined 30-day all-cause readmission for Medicare fee-for-service beneficiaries treated for ischemic stroke (ICD-9 433,434, 436) in FL CReSD hospitals from 2010-2013. We fit a Cox proportional hazards model that censored for death and adjusted for age, sex, and comorbidities to assess race-ethnic differences in readmission, and identified reasons for readmissions. Results: Among 16,952 unique ischemic stroke patients (54% women, 75% white, 8% black, 15% Hispanic), all-cause 30-day readmission was 15%. Readmission rates were 17.2% for Blacks, 16.7% for Hispanics, 14.4% for Whites, and 14.7% for Others (p=0.003). There was a median of 11 days between discharge and first readmission. In risk-adjusted analyses, there was no significant difference in 30-day readmission for Blacks (hazard ratio 1.15, 95% confidence interval 0.99-1.33), Hispanics (1.00, 0.90-1.13), and those of other race (0.91, 0.71-1.16) compared to Whites. Nearly 1 in 4 readmissions were attributable to an acute cerebrovascular event: 16.6% ischemic stroke or transient ischemic attack, 1.5% hemorrhagic stroke, and 5.2% cerebral artery intervention (carotid endarterectomy or stenting, endovascular). Interventions were more common among Whites (6.0%) and those of other race (7.5%) than among Blacks (1.8%) and Hispanics (3.8%; p=0.029). Readmission due to pneumonia or urinary tract infection was 8.2%. Conclusions: Readmissions varied by race/ethnicity, but generally occurred within two weeks of hospital discharge. Our results underscore the importance of post-discharge transition of care and the need for better secondary stroke prevention strategies early after ischemic stroke. Implementation of effective transition of care after acute stroke hospitalization may reduce potentially preventable readmissions, particularly among minority populations.