Key result
Hospitals in the highest utilizing quintile of occupational therapy had lower 30-day readmission rates compared to the lowest quintile (12.3% vs 16.2%).
Why the study?
Do specific hospital-level practice patterns of care reduce 30-day unplanned readmission in adult patients hospitalized for ischemic stroke?
Cohort
Yes
Do specific hospital-level practice patterns of care reduce 30-day unplanned readmission in adult patients hospitalized for ischemic stroke?
Absolute Event Rate: 12.3% vs 16.2%
Hospital-level practices, such as the use of occupational therapy and transfer rates, are associated with 30-day readmission rates after ischemic stroke, highlighting complex systemic factors in stroke care.
Higher occupational therapy use was associated with fewer stroke readmissions; leaves open whether increasing utilization improves outcomes.
OBJECTIVE: To inform stroke quality improvement initiatives by determining the relationship between hospital-level stroke practices and readmission after accounting for patient-level factors. METHODS: Retrospective cohort study of adult patients hospitalized for ischemic stroke (principal ICD-9-CM codes 433.x1, 434.x1, and 436) in 5 states from 2003 to 2009 from State Inpatient Databases. The primary outcome was any unplanned readmission within 30 days. Multilevel logistic regression was used to estimate the association between hospital-level practice patterns of care (diagnostic testing, procedures, intensive care unit, tissue plasminogen activator, and therapeutic modalities) and readmission after adjustment for patient factors and whether individual patients received a given practice. RESULTS: Thirty-day unplanned readmission occurred in 15.2% of stroke admissions; the median hospital readmission rate was 13.6% (interquartile range 9.8%-18.2%). Of the 25 hospital practice patterns of care analyzed, 3 practices were associated with readmission: hospitals with higher use of occupational therapy and higher proportion of transfers from other hospitals had lower adjusted readmission rates, whereas hospitals with higher use of hospice had higher predicted readmission rates. Readmission rates in lowest vs highest utilizing quintile were as follows: occupational therapy 16.2% (95% confidence interval [CI] 14.5%-18.0%) vs 12.3% (95% CI 11.3%-13.2%); transfers 13.8% (95% CI 13.2%-14.5%) vs 12.5% (95% CI 11.6%-13.5%); and hospice 13.1% (95% CI 12.3%-14.0%) vs 14.8% (95% CI 13.5%-16.1%). CONCLUSIONS: Hospital practices have a role in stroke readmission that is complex and poorly understood. Further work is needed to identify specific strategies to reduce readmission rates and to ensure that public reporting of readmission rates will not result in adverse unintended consequences.
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Burke et al. (2014) conducted a cohort in ischemic stroke. High hospital-level use of occupational therapy vs. Low hospital-level use of occupational therapy was evaluated on any unplanned readmission within 30 days. Hospitals in the highest utilizing quintile of occupational therapy had lower 30-day readmission rates compared to the lowest quintile (12.3% vs 16.2%).
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