Ethnic Comparison of 30-Day Potentially Preventable Readmissions After Stroke in Hawaii

Abstract

Background and Purpose Ethnic disparities in readmission after stroke have been inadequately studied. We sought to compare potentially preventable readmissions (PPR) among a multiethnic population in Hawaii. Methods Hospitalization data in Hawaii from 2007-2012 were assessed to compare ethnic differences in 30-day PPR following stroke-related hospitalizations. Multivariable models using logistic regression were performed to assess the impact of ethnicity on 30-day PPR after controlling for age group (<65, ≥65 years), sex, insurance, county of residence, substance use, history of mental illness and Charlson Comorbidity Index (CCI). Results Thirty-day PPR was seen in 840 (8.4%) of 10,050 any stroke-related hospitalizations, 712 (8.7%) of 8,161 ischemic stroke hospitalizations, and 128 (6.8%) of 1,889 hemorrhagic stroke hospitalizations. In the multivariable models, only the Chinese ethnicity, compared to whites, was associated with 30-day PPR after any stroke hospitalizations (OR [95% CI]: 1.40 [1.05, 1.88]) and ischemic stroke hospitalizations (1.42 [1.04, 1.96]). When considering only one hospitalization per individual, the impact of Chinese ethnicity on PPR after any stroke hospitalization (1.22 [0.89, 1.68]) and ischemic stroke hospitalization (1.21 [0.86, 1.71]) were attenuated. Other factors associated with 30-day PPR after any stroke hospitalizations were CCI [per unit increase] (1.21 [1.18, 1.24]), Medicaid (1.42 [1.07, 1.88]), Hawaii county (0.78 [0.62, 0.97]), and mental illness (1.37 [1.10, 1.70]). Conclusion In Hawaii, Chinese may have a higher risk of 30-day PPR after stroke compared to whites. However, this appears to be driven by the high number of repeated PPR within the Chinese ethnic group.

Annual incidences and predictors of 30-day readmissions following spontaneous intracerebral hemorrhage from 2010 to 2014 in the United States: A retrospective Nationwide analysis

“…It is possible that a large number of these patients did not survive the index admission, given age is a known risk factor for mortality in sICH. Unsurprisingly, greater comorbidity burden increased patients' odds of readmission, a finding that has been reported previously in other stroke subtypes [18,34]. Compared to hospitals in large metropolitan locations, those in smaller cities experienced lower readmission rates, although this finding may have been influenced by lower case severity in the latter.…”

“…Furthermore, characterizing the most common causes of readmission could improve surveillance for complications after discharge that would most likely lead to readmission. A national perspective on 30dRAs after sICH in the United States is lacking, with current data primarily limited to relatively small single institution or single state cohorts [2,7,16,18]. Although a prior study has used the NRD to evaluate 30dRAs among patients with ICH, they included all forms of stroke, did not exclude patients with underlying vascular or neoplastic lesions, and did not provide a detailed analysis of clinically relevant patient characteristics that influenced readmission [33].…”

“…Stroke was recently added to the list of conditions in which 30dRAs are penalized by the ACA, which prompted numerous studies that analyzed readmission rates for various cerebrovascular insults [1,2,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26]. Despite recent efforts, there remains limited knowledge regarding annual trends and risk factors for 30dRA among patients with spontaneous intracerebral hemorrhage (sICH).…”

Five-year readmission and mortality differ by ischemic stroke subtype

“…230 Another study found that increasing comorbidity, insurance type, and mental illness were associated with potentially preventable readmissions, which represented 8.4% of all 30-day readmissions after stroke. 231 Some of the factors that we have found to be associated with readmission, such as age and history of atherosclerotic disease, are hard to influence, but other factors like acute complications, hypertension, atrial fibrillation, and possibly functional outcome, are modifiable and can be targeted to improve both early and late readmissions.…”

“…241 Such interventions proved useful in a quality improvement project on stroke patients, with a subsequent reduction of 30-day readmission rates from 9% to 3% and a reduction from 16% to 12% in emergency department visits. 243 diabetes mellitus, heart failure, and dehydration, 230,231 whereas others have reviewed the medical records for determination of readmissions that could have been avoided. 152,248 Between 2% and 31% of all unplanned readmission within 30 days have been considered preventable.…”