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Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke

IMPORTANCE: Readmission reduction is linked to improved quality of care, saves cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for patients with stroke are unavailable to date. Such estimates are necessary for benchmarking performance. OBJECTIVES: To...

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Autores principales: Bambhroliya, Arvind B., Donnelly, John P., Thomas, Eric J., Tyson, Jon E., Miller, Charles C., McCullough, Louise D., Savitz, Sean I., Vahidy, Farhaan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324273/
https://www.ncbi.nlm.nih.gov/pubmed/30646112
http://dx.doi.org/10.1001/jamanetworkopen.2018.1190
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author Bambhroliya, Arvind B.
Donnelly, John P.
Thomas, Eric J.
Tyson, Jon E.
Miller, Charles C.
McCullough, Louise D.
Savitz, Sean I.
Vahidy, Farhaan S.
author_facet Bambhroliya, Arvind B.
Donnelly, John P.
Thomas, Eric J.
Tyson, Jon E.
Miller, Charles C.
McCullough, Louise D.
Savitz, Sean I.
Vahidy, Farhaan S.
author_sort Bambhroliya, Arvind B.
collection PubMed
description IMPORTANCE: Readmission reduction is linked to improved quality of care, saves cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for patients with stroke are unavailable to date. Such estimates are necessary for benchmarking performance. OBJECTIVES: To provide US nationwide estimates and a temporal trend for overall, planned, and potentially preventable 30-day hospital readmission among patients with ischemic and hemorrhagic stroke; to investigate the association between hospitals’ stroke discharge volume, teaching status, and 30-day readmission; and to highlight reasons for 30-day readmission and explore the association of 30-day readmission in terms of mortality, length of stay, and cost of care among patients with stroke. DESIGN, SETTING, AND PARTICIPANTS: Cohort, year-wise analysis of the Nationwide Readmissions Database between January 1, 2010, and September 30, 2015. The setting was a population-based cohort study providing national estimates of 30-day readmission. The database represents 50% of all US hospitalizations from 22 geographically dispersed states. Participants were adult (≥18 years) patients with a primary discharge diagnosis of intracerebral hemorrhage, acute ischemic stroke, or subarachnoid hemorrhage. Hospitals were categorized by their annual stroke discharge volume and were classified as teaching hospitals if they had an American Medical Association–approved residency program or had a ratio of full-time equivalent interns and residents to beds of 0.25 or higher. MAIN OUTCOMES AND MEASURES: Readmission was defined as any admission within 30 days of index hospitalization discharge. Using Centers for Medicare & Medicaid Services–defined algorithms, events were classified as planned or unplanned and as potentially preventable. RESULTS: Based on study criteria, 2 078 854 eligible patients were included (mean [SE] age, 70.02 [0.07] years; 51.9% female). Thirty-day readmission was highest for patients with intracerebral hemorrhage (13.70%; 95% CI, 13.40%-13.99%), followed by patients with acute ischemic stroke (12.44%; 95% CI, 12.33%-12.55%) and patients with subarachnoid hemorrhage (11.48%; 95% CI, 11.01%-11.96%). On average, there was a 3.3% annual decline in readmission between 2010 and 2014, which was statistically significant for the period of investigation (odds ratio, 0.96; 95% CI, 0.95-0.97). Patients discharged from nonteaching hospitals with high stroke discharge volume were at a significantly higher risk of 30-day readmission, and the top 2 reasons for readmission were acute cerebrovascular disease and septicemia. CONCLUSIONS AND RELEVANCE: This study suggests that nationally representative readmission metrics can be used to benchmark hospitals’ performance, and a temporal trend of 3.3% may be used to evaluate the effectiveness of readmission reduction strategies.
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spelling pubmed-63242732019-01-22 Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke Bambhroliya, Arvind B. Donnelly, John P. Thomas, Eric J. Tyson, Jon E. Miller, Charles C. McCullough, Louise D. Savitz, Sean I. Vahidy, Farhaan S. JAMA Netw Open Original Investigation IMPORTANCE: Readmission reduction is linked to improved quality of care, saves cost, and is a desirable patient-centered outcome. Nationally representative readmission metrics for patients with stroke are unavailable to date. Such estimates are necessary for benchmarking performance. OBJECTIVES: To provide US nationwide estimates and a temporal trend for overall, planned, and potentially preventable 30-day hospital readmission among patients with ischemic and hemorrhagic stroke; to investigate the association between hospitals’ stroke discharge volume, teaching status, and 30-day readmission; and to highlight reasons for 30-day readmission and explore the association of 30-day readmission in terms of mortality, length of stay, and cost of care among patients with stroke. DESIGN, SETTING, AND PARTICIPANTS: Cohort, year-wise analysis of the Nationwide Readmissions Database between January 1, 2010, and September 30, 2015. The setting was a population-based cohort study providing national estimates of 30-day readmission. The database represents 50% of all US hospitalizations from 22 geographically dispersed states. Participants were adult (≥18 years) patients with a primary discharge diagnosis of intracerebral hemorrhage, acute ischemic stroke, or subarachnoid hemorrhage. Hospitals were categorized by their annual stroke discharge volume and were classified as teaching hospitals if they had an American Medical Association–approved residency program or had a ratio of full-time equivalent interns and residents to beds of 0.25 or higher. MAIN OUTCOMES AND MEASURES: Readmission was defined as any admission within 30 days of index hospitalization discharge. Using Centers for Medicare & Medicaid Services–defined algorithms, events were classified as planned or unplanned and as potentially preventable. RESULTS: Based on study criteria, 2 078 854 eligible patients were included (mean [SE] age, 70.02 [0.07] years; 51.9% female). Thirty-day readmission was highest for patients with intracerebral hemorrhage (13.70%; 95% CI, 13.40%-13.99%), followed by patients with acute ischemic stroke (12.44%; 95% CI, 12.33%-12.55%) and patients with subarachnoid hemorrhage (11.48%; 95% CI, 11.01%-11.96%). On average, there was a 3.3% annual decline in readmission between 2010 and 2014, which was statistically significant for the period of investigation (odds ratio, 0.96; 95% CI, 0.95-0.97). Patients discharged from nonteaching hospitals with high stroke discharge volume were at a significantly higher risk of 30-day readmission, and the top 2 reasons for readmission were acute cerebrovascular disease and septicemia. CONCLUSIONS AND RELEVANCE: This study suggests that nationally representative readmission metrics can be used to benchmark hospitals’ performance, and a temporal trend of 3.3% may be used to evaluate the effectiveness of readmission reduction strategies. American Medical Association 2018-08-17 /pmc/articles/PMC6324273/ /pubmed/30646112 http://dx.doi.org/10.1001/jamanetworkopen.2018.1190 Text en Copyright 2018 Bambhroliya AB et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Bambhroliya, Arvind B.
Donnelly, John P.
Thomas, Eric J.
Tyson, Jon E.
Miller, Charles C.
McCullough, Louise D.
Savitz, Sean I.
Vahidy, Farhaan S.
Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title_full Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title_fullStr Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title_full_unstemmed Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title_short Estimates and Temporal Trend for US Nationwide 30-Day Hospital Readmission Among Patients With Ischemic and Hemorrhagic Stroke
title_sort estimates and temporal trend for us nationwide 30-day hospital readmission among patients with ischemic and hemorrhagic stroke
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324273/
https://www.ncbi.nlm.nih.gov/pubmed/30646112
http://dx.doi.org/10.1001/jamanetworkopen.2018.1190
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