title: Many Neurology Readmissions Are Nonpreventable.
abstract: BACKGROUND
  Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services' (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review.
  
  
  METHODS
  We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned.
  
  
  RESULTS
  A total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase,P< .001) and estimated length of stay (OR = 1.04,P= .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not.
  
  
  CONCLUSIONS
  Many neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Sidney T
authors.initials: ST
authors.lastname: Le
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
authors.affiliation: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Hans A
authors.initials: HA
authors.lastname: Puttgen
authors.affiliation: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Lorrie
authors.initials: L
authors.lastname: Gibson
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Elan L
authors.initials: EL
authors.lastname: Guterman
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Leicester
authors.affiliation: University of California San Francisco, San Francisco, CA, USA.
authors.forename: Carla L
authors.initials: CL
authors.lastname: Graf
authors.affiliation: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Probasco
keywords: clinical specialty; general neurology; neurohospitalist; neurosurgery; quality; safety; techniques