title: Post-Acute Care Data for Predicting Readmission After Ischemic Stroke: A Nationwide Cohort Analysis Using the Minimum Data Set.
abstract: BACKGROUND
  Reducing hospital readmissions is a key component of reforms for stroke care. Current readmission prediction models lack accuracy and are limited by data being from only acute hospitalizations. We hypothesized that patient-level factors from a nationwide post-acute care database would improve prediction modeling.
  
  
  RESULTS
  Medicare inpatient claims for the year 2008 that used International Classification of Diseases, Ninth Revision codes were used to identify ischemic stroke patients older than age 65. Unique individuals were linked to comprehensive post-acute care assessments through use of the Minimum Data Set (MDS). Logistic regression was used to construct risk-adjusted readmission models. Covariates were derived from MDS variables. Among 39 178 patients directly admitted to nursing homes after hospitalization due to acute stroke, there were 29 338 (75%) with complete MDS assessments. Crude rates of readmission and death at 30 days were 8448 (21%) and 2791 (7%), respectively. Risk-adjusted models identified multiple independent predictors of all-cause 30-day readmission. Model performance of the readmission model using MDS data had a c-statistic of 0.65 (95% CI 0.64 to 0.66). Higher levels of social engagement, a marker of nursing home quality, were associated with progressively lower odds of readmission (odds ratio 0.71, 95% CI 0.55 to 0.92).
  
  
  CONCLUSIONS
  Individual clinical characteristics from the post-acute care setting resulted in only modest improvement in the c-statistic relative to previous models that used only Medicare Part A data. Individual-level characteristics do not sufficiently account for the risk of acute hospital readmission.
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (C.R.F., L.C.W., B.B.T., S.P.).
authors.forename: Corey R
authors.initials: CR
authors.lastname: Fehnel
authors.affiliation: Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (Y.L., V.M.).
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (C.R.F., L.C.W., B.B.T., S.P.).
authors.forename: Linda C
authors.initials: LC
authors.lastname: Wendell
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (C.R.F., L.C.W., B.B.T., S.P.).
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Thompson
authors.affiliation: Division of Neurocritical Care, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI (C.R.F., L.C.W., B.B.T., S.P.).
authors.forename: N Stevenson
authors.initials: NS
authors.lastname: Potter
authors.affiliation: Department of Health Services, Policy & Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI (Y.L., V.M.).
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D016344:Medicare Part A; D009735:Nursing Homes / Q000592:standards; D016017:Odds Ratio; D010351:Patient Discharge; D010359:Patient Readmission; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012919:Social Behavior; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014481:United States
keywords: health care policy; health services research; ischemic stroke; outcomes; readmission