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(Stroke. 2000;31:1038.)
© 2000 American Heart Association, Inc.

Original Contributions

Can Readmission After Stroke Be Prevented?

Results of a Randomized Clinical Study: A Postdischarge Follow-Up Service for Stroke Survivors

Hanne Elkjær Andersen, MD; Kirsten Schultz-Larsen, MD, PhD; Svend Kreiner, MSc; Birgitte Hysse Forchhammer, CPsych, PhD; Karen Eriksen, PT Anne Brown, PT

From the Center for Elder Research (H.E.A., K.S.-L., B.H.F., K.E., A.B.), University Hospital H:S Bispebjerg, Copenhagen, Denmark; and Department of Biostatistics (S.K.), Institute of Public Health, University of Copenhagen, Panum Institute, Copenhagen, Denmark.

Correspondence to Dr Hanne Elkjær Andersen, Center for Elder Research, University Hospital H:S Bispebjerg, Oester Farimagsgade 5, DK1399 Copenhagen, Denmark. E-mail hanneelkjaer{at}dadlnet.dk

Background and Purpose—About 50% of stroke survivors are discharged to their homes with lasting disability. Knowledge, however, of the importance of follow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after discharge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report the results regarding readmission.

Methods—This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilitation, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to standard aftercare. Fifty-four received follow-up home visits by a physician (INT1-HVP), 53 were provided instructions by a physiotherapist in their home (INT2-PI), and 48 received standard aftercare only (controls). Baseline characteristics for the 3 groups were comparable. Six months after discharge, data were obtained on readmission and institutionalization.

Results—The readmission rates within 6 months after discharge were significantly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmission risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicating that the effect of intervention was strongest for patients with a prolonged inpatient rehabilitation.

Conclusions—Readmission is common among disabled stroke survivors. Follow-up intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.

Key Words: randomized controlled trial • rehabilitation • stroke outcome • stroke management

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