Abstract WP440: Stay at Home With Home Care: The Evidence for Readmission Reduction With Home Visits After Ischemic Stroke

Abstract

Background: Following hospitalization due to ischemic stroke (IS), 14.4% of Medicare recipients are readmitted within 30 days. Readmission after IS is associated with increased mortality, disability, and elevated costs. Purpose: To identify evidence-based practices to guide reduction of all-cause, 30-day hospital readmissions following IS in a comprehensive stroke center (CSC). Methods: A literature review focusing on readmissions in IS patients was performed using the PubMed, CINAHL, Embase, and Web of Science databases. Search terms: hospital readmission, IS, transition of care, and care transition. Limitations included English publications in the last 5 years. The 39 articles and abstracts reviewed included 2 meta-analyses, 4 literature reviews, 2 randomized controlled trials, 2 qualitative studies, 2 program evaluations, 2 design descriptions without results, and the remainder observational and cohort studies. Most studies were single site or limited geographic areas. Differing patient populations, definitions, and study methods limited the ability to combine results. Literature review results were then compared with baseline practices at our CSC. Results: While multiple best-practices were in place at our CSC, only 44% of IS patients were being referred to home care. Six of the publications reviewed identified home care as a successful component in reducing readmissions within 30 days, reporting statistically significant reduction in readmission rates ranging from 30% to 93% with 3 of 6 reporting p< .05, treatment effect of 1.7 reported by 1, and 2 study groups did not report significance of findings. Conclusions: Reducing readmissions for IS improves outcomes and is a focus of quality efforts across the nation. Using literature, we identified a gap in current best practices (the under-utilization of home care referrals) in our CSC. Despite limitations in the literature, there is clear evidence that the use of home care has reduced readmissions in multiple settings. This has been a successful first step in guiding development of an evidence-based readmission reduction program. An initiative to increase home care utilization at our CSC is currently under evaluation. More study is needed on home care use in the stroke-specific population.