Introduction: Readmission (RA) after stroke is an established quality of care metric and is tied to reimbursements. Administrative databases lack stroke-specific severity indicators and information on post-discharge mortality. We report the cumulative incidence of 30-day RA for patients with primary intracerebral hemorrhage (ICH) from a statewide prospective cohort.
Methods: Eligible ICH patients are consented to participate in the cohort to assess the impact of level of care on patient-centered outcomes across Texas. Patients undergo inpatient evaluation, followed by 30- and 90-day assessments for functional, cognitive, quality of life, dependency, and resource utilization outcomes. We defined 30-day RA as any RA that was assessed 30 days post-acute care hospitalization for the index ICH event. We used survival analyses to provide hazard ratios (HR) and 95% confidence interval (CI), while modeling post-discharge mortality as a competing risk.
Results: Thus far, 158 patients have been enrolled with RA information available for 104. The overall RA rate is 5.1 / 1000 person-days (CI: 3.1-8.3). Among the various factors evaluated (Table 1), 30-day RA is significantly higher for patients with a higher ICH score (HR: 5.67, CI: 1.45-22.19), whereas post-discharge rehabilitation (as compared to discharge to home) appears to reduce the risk of RA, even after accounting for institution-free period of observation (HR: 0.11, CI: 0.01-0.86). Among patients with a high ICH score, those discharged home had significantly higher risk of RA as compared to those who received rehabilitation (Figure 1). Enrollment is continuing; updated analyses will be presented.
Conclusion: Stroke-specific disease severity factors are important to identify to develop effective preventive strategies against RA, and need to be controlled for when comparing RA metrics across patient populations. Influence of post-stroke rehab on curtailing RA for ICH patients needs to be explored further.