title: Continuity of care and 30-day readmission for patients evaluated in the emergency room after cerebral aneurysm treatment.
abstract: BACKGROUND
  The association between continuity of care and the rate of 30-day readmissions after surgical procedures continues to be debated.
  
  
  OBJECTIVE
  To investigate the association of 30-day readmissions with evaluation in the hospital where the original procedure was performed for patients presenting to the emergency department (ED) after cerebral aneurysm treatment.
  
  
  METHODS
  We performed a cohort study of patients with cerebral aneurysms, who were evaluated in the ED within 30 days after discharge following surgical clipping or endovascular coiling between 2009 and 2013, and were registered in the Statewide Planning and Research Cooperative System database. A propensity score adjusted model was used to control for confounding, whereas mixed effects accounted for clustering at the hospital level.
  
  
  RESULTS
  Of the 452 patients presenting to the ED, 218 (48.2%) were evaluated in a different hospital from that in which the original procedure was performed (7.7% readmitted), and 234 (51.8%) were evaluated at the original hospital (18.4% readmitted). In a multivariable analysis, we showed that evaluation in the ED of the original hospital was associated with decreased rate of 30-day readmission (OR=0.41; 95% CI 0.22 to 0.78). We found similar associations in a mixed-effects logistic regression model (OR=0.46; 95% CI 0.35 to 0.84) and a propensity score adjusted model (OR=0.41; 95% CI 0.22 to 0.77). This corresponds to10 patients needing to be evaluated in the hospital at which the original procedure was performed to prevent one readmission.
  
  
  CONCLUSIONS
  Using a comprehensive all-payer cohort of patients in New York State, who were evaluated in the ED after cerebral aneurysm treatment, we identified an association between assessment in the hospital at which the original procedure was performed and a lower rate of 30-day readmissions. This underlines the potential importance of continuity of care for surgical patients to prevent readmission.
authors: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
authors: Kimon
authors: K
authors: Bekelis
authors: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors: Symeon
authors: S
authors: Missios
authors: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors: Todd A
authors: TA
authors: MacKenzie
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000639:trends*; D004636:Emergency Service, Hospital / Q000639:trends*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000628:therapy*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm