Readmission risk assessment questionnaire development for ischaemic stroke survivors: a Delphi study

The incidence of readmission among ischaemic stroke (IS) survivors is high. Thirty-day (30d) readmission directly increases medical costs and suffering among survivors and indirectly reflects the lack of medical quality. Many studies have analysed 30d readmission risk factors, but no effective readmission risk assessment tool has been developed to guide clinical work. This study aims to develop the Readmission Risk Assessment Questionnaire for IS survivors (RRAQ-IS) for future clinical validation. A Delphi study. At first, we formed a research group included epidemiologist, professor of neurology and nursing expert. The first questionnaire draft was developed based on an extensive literature review and the Bio-Psycho-Social Medical Model. Seven databases were searched from inception to April 30, 2021. Retrospective or prospective observational studies and interventional studies focusing on 30d readmission risk factors in survivors with ischaemic stroke were included. The two-round Delphi method was adopted to adjust the dimensions and items of questionnaire draft. Finally, the analytic hierarchy process (AHP) was used to determine the weights of questionnaire dimensions and items. We conducted two rounds of expert consultation and consulted 17 experts. Twenty-eight expert opinions were received. The expert positive coefficients were 80.95% and 100%, respectively. The degrees of expert authority were 0.877 and 0.891, respectively. In the first round, 2 items were deleted. In the second round, the CVs of all dimensions and items ranged from 0.079 to 0.192; the CV of questionnaire was 0.083; and Kendall's W coordination coefficient was 0.424 ( P < 0.001). The AHP revealed that the consistency ratios of three dimensions were 0.0266, 0.0456 and 0.0266. RRAQ-IS has 12 items and 3 dimensions. The total score of the RRAQ-IS is the sum of the 12 item scores and ranges from 0 to 24 points. The higher the total RRAQ-IS score, the higher the 30d readmission risk. Based on literature review, the Delphi method and the AHP, we developed a RRAQ-IS. Clinicians may use it to assess the 30d readmission risk of IS survivors at discharge. However, RRAQ-IS ultimately don’t include the psychological factors recommended by the Bio-Psycho-Social Medical Model. We don’t conduct clinical application study in IS survivors, and measuring reliability, construct validity, criterion-related validity and predictive validity of RRAQ-IS requires future study.