Systematic Review of Hospital Readmissions in Stroke Patients

Abstract

Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n = 2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.

A retrospective cohort study of high-impact users among patients with cerebrovascular conditions

“…which have shown these conditions having an impact on the readmission rate. 30 Disease management factors included discharge to nursing home, thrombolysis, disease-related procedures (carotid endarterectomy, craniectomy, carotid stenting, aneurysm repair, and craniotomy), the use of other procedures (tracheostomy, intubation, urinary catheterisation, invasive or non-invasive ventilation, percutaneous endoscopic gastrostomy or nasogastric tube insertion, and renal replacement therapy) and LOS. The management factors used in this study had been previously assessed using administrative data.…”

“…Certain covariates may be inter-related, but each of them was shown to have an impact on the readmission rate independent of the other factors. 30 Hence, they were separately included in the analysis. Adjusted ORs were calculated by the use of multinomial logistic regression where the low-impact group was used for comparison.…”

Optimizing the use of digital sensors (non-invasive) for early detection of risk factors for recurrent stroke to improve quality of care: A systematic review

“…Secondary prevention consists of risk factor management, intervention to resolve vascular obstruction, anti-thrombolytic therapy for cardio embolic stroke, and antiplatelet therapy for non-cardio embolic stroke. Nurses play an important role as educators in secondary prevention by providing health information for controlling risk factors 5 . Studies addressing knowledge about the risk of impending stroke had been focused on the community as a whole.…”

“…Various prevention and behavior change programs have been implemented. However, these have not significantly reduced the prevalence of recurrent stroke and re-admission rate 5 . Health professionals are facing a challenge to provide health education to the community and make a breakthrough to improve awareness about stroke or recurrent stroke, especially awareness among those who possess higher risk factors.…”

“…Approximately 13% of patients with stroke are affected by recurrent stroke within the first year after the initial event 4 . A systematic review reported that recurrent stroke was the major reason for hospital re-admission among patients with ischemic stroke within the first 30 days and 1 year following the initial event, (33% and 26.3%, respectively) 5 . Hospitals are currently challenged to reduce preventable hospital re-admission for cost retrenchment and improvement of service quality.…”