Study: Depression, social factors linked to rehospitalization post-stroke

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Signs of depression, lacking social networks and poor function are factors that help land stroke patients back in the hospital within three months of inpatient rehab, according to a study in the April 6 issue of the Journals of Gerontology Series A: Biological Sciences and Medical Sciences. Researchers said more work focused on improving post-acute care is necessary, especially as reporting of these quality indicators will soon be mandated by the Patient Protection and Affordable Care Act (PPACA).

“The majority of patients who experience a stroke are older than 65 years of age and have at least one comorbid condition making them a high risk for hospital readmission,” wrote Kenneth J. Ottenbacher, PhD, of the University of Texas Medical Branch in Galveston, Texas, and colleagues. Now, mandates buried within the pages of the PPACA will require inpatient rehab facilities who receive Medicare payments to submit quality indicator data by 2014 (Federal Register 2011;76:151).

Few studies have examined sociodemographic and clinical factors related to hospital readmission for stroke patients. Therefore, Ottenbacher et al set out to assess these factors in stroke patients who received post-acute inpatient rehabilitation during a 700-patient study taking place at nine facilities across eight states between 2005 and 2006. The patients were identified using the Stroke Underserved Populations Recovery database and data were collected during follow-up interviews 72 hours post-discharge and three months later.

Ottenbacher and colleagues reported that 18 percent of the patients enrolled in the study were rehospitalized within three months following discharge from an inpatient rehabilitation center. Patients who were admitted for hospitalization were more likely to be non-Hispanic whites and married, have less functional dependence, experienced longer length of stay during rehab visits and had hints of depression. In addition, these patients were less likely to have a good social support system.

"By identifying clear demographic, clinical and environmental factors that lead to rehospitalization, we can develop meaningful quality indicators for post-acute care that target ways to improve patients' health and contain costs by reducing the likelihood of readmission," Ottenbacher said in a statement.

These studies coincide with other studies that have concluded that functional status has consistently resulted in higher rehospitalizations and mortality. In the current study, based on Duke Social Support scores, the researchers noted that patients with low levels of social support were twice as likely to be rehospitalized when compared with those who had tight social circles.

Rehospitalization rates were also 80 percent greater for patients with depressive symptom scores of 16 or greater. But for white patients, signs of depression increased the risk of rehospitalization 21 percent. Minorities with these same symptoms saw a 5 percent lower risk of being readmitted.

“The Centers for Medicare & Medicaid Services and MedPAC have noted the lack of research regarding hospital readmission following inpatient medical rehabilitation,” the authors wrote. “Our findings begin to address this issue and indicate that functional status, depressive symptoms and social support are important predictors of hospital readmission; however, these variables are not currently available in most administrative data sets.”

The authors concluded that more work will need to be done to better understand the factors that are most associated with rehospitalization post-inpatient rehabilitation.