Abstract T P297: The Minimum Data Set: A Tool for Nationwide Assessment of Readmission After Ischemic Stroke
Background: Hospital readmission is a primary focus for health care quality improvement, and a key provision in the Affordable Care Act. Current models predicting risk for readmission are limited by a lack of individual level data. The Minimum Data Set (MDS) for nursing home resident assessment offers a unique opportunity to better understand individual risk factors for readmission. An analysis was performed to evaluate whether sufficient and reliable data exist for further study.
Methods: Medicare inpatient hospital discharge claims for the year 2008 among persons more than age 65 discharged to Skilled Nursing Facilities were used to identify cases by ICD-9 codes for Acute Ischemic Stroke (430.x, 431.x, 433.x, 434.x, and 436.x). Linkage of the sample to full MDS records was performed by matching Medicare claim number, social security number, and date of birth. Demographic characteristics of the sample were ascertained by linking inpatient claims with Medicare Enrollment Files. Mortality and readmission rates were determined using hospital claims and the enrollment record for the analytical sample at intervals of at 30, 60, and 90 days post-hospital discharge.
Results: Among 410,825 subjects meeting study inclusion criteria, unique record linkage with the Minimum Data Set was available for 143,150 subjects. Mean age was 82.1(± SD 7.8), and 63% were female. Unadjusted mortality rates among Medicare Part A claims at 30, 60, and 90 days were 14%, 16%, and 17% respectively. Unadjusted mortality rates among MDS records at 30, 60, and 90 days were 10%, 13%, and 14% respectively. Readmission rates among Medicare Part A claims at 30, 60, and 90 days were 14%, 21%, and 26% respectively. Readmission rates among MDS records at 30, 60, and 90 days was 23%, 32%, and 39% respectively.
Conclusions: A large nationwide sample representing 35% of Medicare ischemic stroke discharges is available through the MDS. A higher proportion of new onset ischemic stroke patients require skilled nursing facility admission than indicated by previous studies in smaller cohorts. Mortality is lower, but readmission is higher among skilled nursing facility residents after ischemic stroke. Future study will utilize the MDS to further define individual risk factors predictive of readmission.
Author Disclosures: C.R. Fehnel: None. Y. Lee: None. V. Mor: Research Grant; Modest; U01 AG032947- National Study of Disability Trends and Dynamics, P01 AG02729 - National Institute on Aging: Shaping Long-Term Care in America, T32 HS-000011 - DHHS: National Research Service Award.
- © 2014 by American Heart Association, Inc.