Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke

Circ Cardiovasc Qual Outcomes. 2018 Apr;11(4):e004024. doi: 10.1161/CIRCOUTCOMES.117.004024.

Abstract

Background: Reducing hospital readmission is an important goal to optimize poststroke care and reduce costs. Early outpatient follow-up may represent one important strategy to reduce readmissions. We examined the association between time to first outpatient contact and readmission to inform postdischarge transitions.

Methods and results: We performed a retrospective cohort study of all Medicare fee-for-service patients discharged home after an acute ischemic stroke in 2012 identified by the InternationalClassification of Diseases, Ninth Revision, Clinical Modification codes. Our primary predictor variable was whether patients had a primary care or neurology visit within 30 days of discharge. Our primary outcome variable was all-cause 30-day hospital readmission. We used separate multivariable Cox models with primary care and neurology visits specified as time-dependent covariates, adjusted for numerous patient- and systems-level factors. The cohort included 78 345 patients. Sixty-one percent and 16% of patients, respectively, had a primary care and neurology visit within 30 days of discharge. Visits occurred a median (interquartile range) 7 (4-13) and 15 (5-22) days after discharge for primary care and neurology, respectively. Thirty-day readmission occurred in 9.4% of patients. Readmissions occurred a median 14 (interquartile range, 7-21) days after discharge. Patients who had a primary care visit within 30 days of discharge had a slightly lower adjusted hazard of readmission than those who did not (hazard ratio, 0.98; 95% confidence interval, 0.97-0.98). The association was nearly identical for 30-day neurology visits (hazard ratio, 0.98; 95% confidence interval, 0.97-0.98).

Conclusions: Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly patients with stroke discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions.

Keywords: aged; confidence intervals; humans; outcome and process assessment (health care); primary health care.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care*
  • Appointments and Schedules*
  • Brain Ischemia / diagnosis
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Databases, Factual
  • Female
  • Humans
  • Male
  • Medicare
  • Patient Discharge
  • Patient Readmission*
  • Primary Health Care*
  • Retrospective Studies
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / physiopathology
  • Stroke / therapy*
  • Time Factors
  • Treatment Outcome
  • United States