Identifying factors associated with hospital readmissions among stroke patients in Taipei.
Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADL), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.
Chuang
Kun-Yang
KY
School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taiwan, ROC.
Wu
Shwu-Chong
SC
Ma
Ai-Hsuan Sandra
AH
Chen
Yu-Hui
YH
Wu
Chen-Long
CL
D000203:Activities of Daily Living; D000359:Aftercare / Q000592:standards; D000367:Age Factors; D000368:Aged; D017281:Cost of Illness; D005260:Female; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D009735:Nursing Homes / Q000706:statistics & numerical data; D010347:Patient Care Planning / Q000592:standards; D010351:Patient Discharge / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology