Editors' note: Readmission to a different hospital following acute stroke is associated with worse outcomes

Abstract

Using the 2013 Nationwide Readmissions Database, which contains patient-level data for nearly half of Americans who were hospitalized for medical illness during that year, Drs. Stein and colleagues examined the length of stay and other outcomes among patients who were readmitted within 30 days of an index stroke event. Although the reported reasons for readmission to a different hospital vs the initial hospital were similar, patients readmitted to a different hospital were more likely to have longer hospitalizations, to incur higher hospitalization costs, and to be more likely to die during readmission. Drs. Chen and colleagues highlighted how social factors—such as dissatisfaction with care at the initial hospital—and index stroke severity or care could have influenced these outcome measures. Although stroke severity and subjective patient satisfaction are data elements that were not specifically captured in this national readmissions database, the authors adjusted for clinical severity using All Patient Refined Diagnosis Related Groups' severity of illness, and they adjusted for each patient's risk of mortality using a standardized score in their final multivariable model. Furthermore, patients were excluded from the analysis if they had been transferred from the index institution to a higher level of care to reduce confounding by unsatisfactory treatment. The effect of prolonged hospitalization with higher costs and a higher mortality rate persists in patients who are readmitted after an acute stroke. Factors that predict readmission need to be carefully considered before initial discharge. Using the 2013 Nationwide Readmissions Database, which contains patient-level data for nearly half of Americans who were hospitalized for medical illness during that year, Drs. Stein and colleagues examined the length of stay and other outcomes among patients who were readmitted within 30 days of an index stroke event. Although the reported reasons for readmission to a different hospital vs the initial hospital were similar, patients readmitted to a different hospital were more likely to have longer hospitalizations, to incur higher hospitalization costs, and to be more likely to die during readmission. Drs. Chen and colleagues highlighted how social factors—such as dissatisfaction with care at the initial hospital—and index stroke severity or care could have influenced these outcome measures. Although stroke severity and subjective patient satisfaction are data elements that were not specifically captured in this national readmissions database, the authors adjusted for clinical severity using All Patient Refined Diagnosis Related Groups' severity of illness, and they adjusted for each patient's risk of mortality using a standardized score in their final multivariable model. Furthermore, patients were excluded from the analysis if they had been transferred from the index institution to a higher level of care to reduce confounding by unsatisfactory treatment. The effect of prolonged hospitalization with higher costs and a higher mortality rate persists in patients who are readmitted after an acute stroke. Factors that predict readmission need to be carefully considered before initial discharge.