Author response: Readmission to a different hospital following acute stroke is associated with worse outcomes.

Abstract

We would like to thank Chen et al.1 for their interest in our study. We agree that it is important to consider stroke severity and the possibility that quality of care was suboptimal during the index admission. Indeed, we specifically designed our analyses to minimize the likelihood that readmissions were related to higher stroke severity or to unsatisfactory treatment at the first hospital. Although the Nationwide Readmissions Database does not include data on stroke severity, we used the All Patient Refined Diagnosis Related Groups (APRDRG) severity of illness and risk of mortality measures as a measure of overall illness severity. Our fully adjusted models account for both APRDRG severity and mortality. To minimize the likelihood that unsatisfactory treatment at the first hospital contributed to readmission, we excluded patients transferred to a higher level of care during index hospitalization. Finally, Table 2 reports the length of hospital stay and total charges of hospitalization during the index admission. In addition to demographics, vascular risk factors, insurance, discharge disposition, and APRDRG severity or mortality, our fully adjusted model also included adjustment for hospital characteristics, length of stay, and total charges during the index hospitalization.