title: Avoidable 30-day readmissions among patients with stroke and other cerebrovascular disease.
abstract: BACKGROUND
  There are limited data on factors associated with 30-day readmissions and the frequency of avoidable readmissions among patients with stroke and other cerebrovascular disease.
  
  
  METHODS
  University HealthSystem Consortium (UHC) database records were used to identify patients discharged with a diagnosis of stroke or other cerebrovascular disease at a university hospital from January 1, 2007 to December 31, 2009 and readmitted within 30 days to the index hospital. Logistic regression models were used to identify patient and clinical characteristics associated with 30-day readmission. Two neurologists performed chart reviews on readmissions to identify avoidable cases.
  
  
  RESULTS
  Of 2706 patients discharged during the study period, 174 patients had 178 readmissions (6.4%) within 30 days. The only factor associated with 30-day readmission was the index length of stay >10 days (vs <5 days; odds ratio [OR] 2.3, 95% CI [1.4, 3.7]). Of 174 patients readmitted within 30 days (median time to readmission 10 days), 92 (53%) were considered avoidable readmissions including 38 (41%) readmitted for elective procedures within 30 days of discharge, 27 (29%) readmitted after inadequate outpatient care coordination, 15 (16%) readmitted after incomplete initial evaluations, 8 (9%) readmitted due to delayed palliative care consultation, and 4 (4%) readmitted after being discharged with inadequate discharge instructions. Only 5% of the readmitted patients had outpatient follow-up recommended within 1 week.
  
  
  CONCLUSIONS
  More than half of the 30-day readmissions were considered avoidable. Coordinated timing of elective procedures and earlier outpatient follow-up may prevent the majority of avoidable readmissions among patients with stroke and other cerebrovascular disease.
authors: Department of Neurology, Emory University, Atlanta, GA, USA.
authors: Fadi
authors: F
authors: Nahab
authors: Jennifer
authors: J
authors: Takesaka
authors: Eugene
authors: E
authors: Mailyan
authors: Lilith
authors: L
authors: Judd
authors: Steven
authors: S
authors: Culler
authors: Adam
authors: A
authors: Webb
authors: Michael
authors: M
authors: Frankel
authors: Dennis
authors: D
authors: Choi
authors: Sandra
authors: S
authors: Helmers
keywords: outcome assessment (health care); patient readmission; stroke
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