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Causes and timing of readmissions after discharge from stroke event
Summary of Data Presented by: Demetrius K. Lopes, MD and Shlee S. Song, MD, FAHA
The leading causes for readmission after stroke change significantly from the point of discharge to the patients’ 90-day milestone. This research highlights CMS retrospective data from over 230,000 Medicare Fee-for-Service (FFS) patients with an incident stroke in the year 2018, originally presented at the 2023 Society of Vascular and Interventional Neurology annual meeting by Dr. Lopes. The data uncovers breaking insights on the documented causes for readmission after stroke and the opportunity to reduce inpatient readmissions.
Readmission Causes During the First Year After Stroke
Inpatient readmissions are very common in the first year after stroke, impacting about 50% of patients². Most readmissions are due to causes other than recurrent stroke. As a result of their new impairments, stroke survivors are uniquely vulnerable to impairment-related causes of readmissions including falls and infections that can lead to sepsis.
They also face significant challenges in navigating their discharge plan and overall recovery. Examining longitudinal Medicare Fee for Service claims data for patients discharged after ischemic and hemorrhagic stroke reveals that the leading cause for readmission transitions from recurrent stroke and TIA to sepsis and infections within 30 days post-discharge².
Analysis of Medicare Fee for Service claims data for patients discharged after ischemic stroke demonstrates that even patients with mild stroke (NIHSS 0-5 on index claim), experience high rates of readmission at 90 days, with 23.5% returning for at least one inpatient hospitalization². A readmission within 90 days of discharge increases a patients' odds of mortality by three times². There is an opportunity to improve patient outcomes and quality of life by reducing preventable readmissions.
Risk Factors in 90-day All-Cause Readmissions After Ischemic Stroke
Within 90 days, 25.9% of Medicare Fee-for-Service (FFS) members discharged alive from an inpatient stroke admission are readmitted to a hospital. We analyzed longitudinal claims data in the year leading up to and including the index stroke admission to explore demographics, comorbidities, and features of index hospitalization that are independently predictive of 90-day readmissions after ischemic stroke discharge.
This research demonstrates that clinical comorbidities are not the only features that impact the risk of readmission. Programs aiming to reduce readmissions after stroke should take a holistic approach that also includes consideration of patient demographics, social determinants of health (SDOH), and features of the index hospital stay.
The table below displays features independently associated with higher or lower risk of 90-day readmissions. Items that are below a 1.0 odds ratio (the horizontal solid black line) are less likely to be associated with a 90-day readmission than those with greater than a 1.0 odds ratio.
The research presented by Dr. Lopes and Dr. Song was conducted in collaboration with Kandu Health using data from the Center for Medicare and Medicaid Services on patients who experienced a stroke in 2018. Additional support by Mary Jo Braid-Forbes, MPH, Braid-Forbes Health Research.
Demetrius K. Lopes, MD is the Cerebrovascular and Comprehensive Stroke Center Surgical Director at Advocate Aurora Health in Park Ridge, IL.
Shlee S. Song, MD, FAHA is the Director of the Comprehensive Stroke and Telestroke Program and Vice Chair of Neurology System Integration at Cedars-Sinai Health System in Los Angeles, CA
