New research published in the Journal of the American Medical Association suggests stroke patients receive better care at teaching hospitals and have reduced rates of readmission during the early stages of their recovery.
“The research is important because readmissions have become a focus for improving quality of care while in a hospital, as well as reducing costs, and very little has been published about stroke patients at this scale,” said lead author Farhaan Vahidy, MBBS, PhD, MPH, of the McGovern Medical School at UTHealth in Houston in a prepared statement. “Our findings help set national performance benchmarks for readmission levels among patients of all ages, types of stroke and insurance classes,” Vahidy said. “This provides potential to identify specific groups for readmission reduction through targeted interventions that improve continued support for discharged patients, which should start before they leave the hospital doors.”
The population-based cohort study is the first of its kind, providing the first comprehensive nationwide analysis of 30-day readmission rates for Medicare and private insurance with various types of stroke—including ischemic and hemorrhagic strokes.
They sought to investigate the association between discharge volume, teaching status and 30-day readmission. They also sought to highlight reasons for 30-day readmission and further analyze the association of 30-day readmission by mortality rates, length of hospital stays and cost of care among patients with stroke.
More than 2 million patients with stroke were included as part of the final study cohort. They found that 14 percent of patients with intracerebral hemorrhage, 12 percent with acute ischemic stroke and 12 percent with subarachnoid hemorrhage were readmitted within 30 days. Upon further analysis, the researchers noted:
- Among patients with stroke of any kind, 30-day hospital readmission decreased annually by 3 percent during the study period.
- Patients discharged from nonteaching hospitals with high stroke discharge volume were at higher risk of readmission due to having another stroke, related complications or septicemia.
- More than 90 percent of all 30-day stroke-related readmissions were unplanned.
- Of the unplanned readmissions, almost 14 percent were preventable. This was dependent on stroke type.
- Patients with hemorrhagic stroke had the greatest risk of readmission at 14 percent.
- Patients with ischemic stroke had a 12 percent risk of readmission.
- There were 46 percent of non-teaching hospital stroke patients.
- The disparity between readmission rates between non-teaching and teaching hospitals continued to grow as the number of stroke patients treated at the non-teaching hospitals grew.
"Many, but not all, patients with more severe stroke are transferred to an academic hospital, which were found to have a steady readmission rate regardless of how many stroke cases were admitted, suggesting superior care," Vahidy said. "These patients are all inherently more vulnerable to stroke recurrence and associated conditions such as septicemia. Patients from nonacademic hospitals, however, seem to be even more prone to this happening as stroke patient volumes increase, indicating opportunities for improvement in pre-discharge patient care and transitional follow-up."
Vahidy and colleagues noted greater adherence to quality-of-care metrics, the use of telestroke technologies, organization of care delivery and outpatient clinics were common among teaching hospitals. These factors, they said, may have given teaching hospitals an advantage over non-teaching centers.
"Our work emphasizes the continued need for more robust approaches and planning strategies to further raise standards, minimize hospital readmissions and improve outcomes for all stroke patients," Vahidy said. "Readmission reduction is a patient-centered outcome. Medicare provides publicly available data for hospitals' performance on readmission in stroke patients. However, additional analyses such as ours are needed to be incorporated, so patients and their families can better advocate for their care and make more informed choices."