Post–Acute Care Data for Predicting Readmission After Ischemic Stroke: A Nationwide Cohort Analysis Using the Minimum Data Set

Abstract

BackgroundReducing hospital readmissions is a key component of reforms for stroke care. Current readmission prediction models lack accuracy and are limited by data being from only acute hospitalizations. We hypothesized that patient-level factors from a nationwide post–acute care database would improve prediction modeling.Methods and ResultsMedicare inpatient claims for the year 2008 that used International Classification of Diseases, Ninth Revision codes were used to identify ischemic stroke patients older than age 65. Unique individuals were linked to comprehensive post–acute care assessments through use of the Minimum Data Set (MDS). Logistic regression was used to construct risk-adjusted readmission models. Covariates were derived from MDS variables. Among 39 178 patients directly admitted to nursing homes after hospitalization due to acute stroke, there were 29 338 (75%) with complete MDS assessments. Crude rates of readmission and death at 30 days were 8448 (21%) and 2791 (7%), respectively. Risk-adjusted models identified multiple independent predictors of all-cause 30-day readmission. Model performance of the readmission model using MDS data had a c-statistic of 0.65 (95% CI 0.64 to 0.66). Higher levels of social engagement, a marker of nursing home quality, were associated with progressively lower odds of readmission (odds ratio 0.71, 95% CI 0.55 to 0.92).ConclusionsIndividual clinical characteristics from the post–acute care setting resulted in only modest improvement in the c-statistic relative to previous models that used only Medicare Part A data. Individual-level characteristics do not sufficiently account for the risk of acute hospital readmission.

Advanced Age and Post–Acute Care Outcomes After Subarachnoid Hemorrhage

“…In contrast to our findings of higher rates of readmission and mortality among low‐volume centers, high‐volume teaching hospitals are more likely to incur Centers for Medicare and Medicaid Services reimbursement penalties for readmissions . Efforts to reliably identify patients with neurologic injuries at risk for readmission have proved challenging . Targeted multidisciplinary team‐based interventions to reduce preventable readmissions have proved beneficial for other conditions .…”

“…30 Efforts to reliably identify patients with neurologic injuries at risk for readmission have proved challenging. 31 Targeted multidisciplinary team-based interventions to reduce preventable readmissions have proved beneficial for other conditions. 32 Potentially important determinants for preventing readmission found in larger, highvolume hospitals include dedicated neurointensive care units, neuroscience-specialized nursing care, social work, case management, and rehabilitation services that may be important determinants of readmission for aSAH.…”

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

“…7-11 In some of the stroke-specific studies, ethnic minorities have also been shown to have higher rates of 30-day readmission after stroke compared to non-Hispanic whites. 12, 13 However, the reported impact of ethnicity on 30-day readmission after stroke has been inconsistent 14 and remains unclear. Furthermore, there is paucity of data on stroke readmissions that have disaggregated Pacific Islanders from Asian Americans.…”

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

“…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).…”