Abstract T MP81: Are 30-Day Stroke Readmissions Preventable?
Introduction: Stroke has a high risk of recurrence and known complications. The expected readmission rate and number of preventable readmissions are difficult to determine. We sought to identify preventable readmissions at an academic medical center in anticipation of CMS pay-for-performance inclusion of 30-day readmission rate as a quality measure.
Methods: Fiscal year 2013 readmissions data were obtained from the Office of Clinical Practice Evaluation. Administrative readmissions were removed and individual chart reviews completed for NIHSS, clinical diagnosis at readmission, and potential contributing factors. Cases were evaluated by a Nurse Practitioner and Neurologist specializing in stroke to determine if the readmission was preventable. Consensus was reached on all cases.
Results: The 30-day readmission rate was 7.47% with 48 readmissions in 46 patients. When compared to all ischemic stroke patients, the readmitted patients were younger (mean age 56 yrs vs 68 yrs) with higher LOS (median 8 days vs 4 days) and comparable NIHSS (mean 8.5 vs 8.8). Stroke or TIA accounted for 7 (14.6%) readmissions. Median number of days to readmission was 7.5, with 47.8% of readmissions occurring within 7 days. Case review determined 27 (56.3%) not to be preventable, 8% were questionable. Outpatient evaluation may have prevented 9 (18.8%), 6.3% were felt to be initial coding errors and should have been removed from the original sample; 10.4% (5) reflected care at the hospital level.
Conclusions: Based on case reviews at our institution less than half of readmissions are preventable, with only about 10% reflecting aspects of a patient’s inpatient care. Categorizing preventable readmissions into administrative, hospital, or outpatient related will assist in development of a plan for readmission reduction. Through collaboration with health information management those patients with unclear coding will be reviewed and revised. Phone calls within 7 days for patients discharged home have increased in regularity. Future planning for participation in Medicare bundled payments for stroke may encourage more collaboration with SNF and Rehabilitation facilities, allowing for evaluation without hospital admission.
Author Disclosures: A.M. Leonhardt: None. C.G. Benesch: None.
- © 2015 by American Heart Association, Inc.