Abstract NS15: A Better Understanding of Readmission After Stroke by Including Stroke Survivor and Caregiver Perspectives
Background: At least 30% of stroke survivors (SSs) are readmitted in the first year after stroke. By identifying factors that lead to readmission, we can develop meaningful quality indicators for post-stroke care that target ways to improve health and support the SSs ability to manage at home. Objectives were to: i) estimate readmission rate in a cohort of older SSs at 1 and 6 months after stroke, ii) identify reasons for readmission, and iii) describe the experience of readmission from the perspective of the SS and family caregiver (CG).
Methods: This mixed-methods study was undertaken utilizing electronic medical records to track readmissions and qualitative interviews were conducted with SSs and CGs. Older adults (≥ 60 years) with stroke admitted to two hospital systems were enrolled in the cohort and followed for 6 months to capture readmissions. A sample of SSs and CGs were interviewed following readmission to gain their perspective related to discharge after stroke and subsequent readmission.
Results: Of the 310 included in the cohort (mean age 76 years, SD 9.8), 10% died prior to discharge. Within one month 10% were readmitted and 25% within 6 months. The main reasons for readmission were recurrent stroke/TIA (19%), pneumonia and urinary tract infection (19%), swallowing problems and dehydration (9%), and cardiac causes (7%). Discharge to a skilled nursing facility (p=.007) and higher Rankin score on discharge (p=.002) were associated with readmission. Semi-structured interviews conducted with 20 SSs and CGs revealed the following themes related to discharge and readmission: discharge preparation that includes their social and cultural context; need for anticipatory guidance on what to expect when home; support for self-management in the community; knowing when to request help; follow-up in the community that could lead to early identification of problems; complexity of medication management; and importance of social support.
Conclusions: The perspective of the SS and CG is critical in identifying potential avenues for intervention, aimed at reducing preventable readmissions. Interventions aimed at the transition between hospital and skilled nursing facilities may reduce readmissions.
Author Disclosures: C.L. White: None. T.L. Brady: None. L.L. Saucedo: None. D. Motz: None. J.A. Sharp: None. L.A. Birnbaum: None.
- © 2014 by American Heart Association, Inc.