Hospital readmission, an important
measure of quality care, costs the United States an estimated $17 billion each
year. And according to the Centers for Medicare and Medicaid Services (CMS), about
half of those readmissions could be avoided.
Therefore, there is significant interest in identifying
factors that influence readmission rates, especially those that can be
identified prior to discharge.
To pinpoint which stroke patients are most at risk, researchers
at Wake Forest Baptist Medical Center undertook a retrospective case-control
study to determine factors associated with readmission within 30 days. The
study is published in the June 11 online edition of the American Journal of
“If you can recognize who is at risk, you can really
focus on those people to try to make sure they are treated appropriately and
followed closely,” said Cheryl Bushnell, M.D., associate professor of neurology
at Wake Forest Baptist and director of its Comprehensive Stroke Center.
The goal of this single-center study was to identify at
the time of discharge the factors that are strongly associated with readmission
in patients with ischemic and hemorrhagic stroke. The study compared 79 stroke patients
who were readmitted to the hospital within 30 days to 86 controls over an 18
month period. There were no significant differences in age, gender or
race-ethnicity between the stroke patients and controls.
The researchers found that readmitted patients were
significantly more likely to have a prior diagnosis of congestive heart
failure, coronary artery disease, cancer or absence of hyperlipidemia, elevated
lipid (fat) levels in the blood. In addition, readmitted patients were more
likely to have been hospitalized two or more times during the year prior to the
initial stroke admission.
The findings suggest that stroke severity and number of hospitalizations
within the year prior to the stroke admission are important predictors of subsequent
readmission within 30 days, independent of other clinical factors, Bushnell
“If our model is validated in a larger study, it could
then be used in electronic health records to provide a potentially
reproducible, efficient and effective means of selecting patients most at risk
for subsequent hospital readmission. A
logical next step is to develop innovative tools and programs for stroke
patients to keep patients from being readmitted,” Bushnell said.
A limitation of the study was that data was collected
solely at discharge, she said, adding that subsequent research will include
evaluation of post-discharge data.
The study was supported by Wake Forest Baptist
Neuroscience Center of Excellence.
Co-authors are Roy E. Strowd, M.D., of Johns Hopkins
University; Starla M. Wise, D.O., U. Natalie Umesi, B.S., Laura Bishop, D.O.,
David Lefkowitz, M.D., Patrick S. Reynolds, M.D., Charles Tegeler, M.D.,
Martinson Arnan, M.D., and Pamela W. Duncan, Ph.D., of Wake Forest Baptist; and
Jeffrey Craig, M.D., of Mercy Hospital in Oklahoma City.