Strokes are a leading cause of hospitalization among the elderly and are one of the biggest contributors to Medicare costs. Lead author Judith Lichtman, an associate professor at YSPH, examined the causes of hospital readmissions for stroke patients and determined that only 1 in 7 readmissions are from potentially preventable causes. The findings are published in the current issue of the journal Stroke.
A major goal of the new Affordable Care Act is to control costs and improve the quality of U.S. health care. Indeed, financial penalties levied by the Centers for Medicare & Medicaid Services (CMS) have affected 75 percent of American hospitals so far this year with excessive readmission rates. CMS has proposed using measures of 30-day readmission for ischemic strokes for payment determination beginning in 2016 (ischemic strokes account for 80 percent of all strokes).
The researchers found that among 307,887 ischemic stroke discharges in the elderly, 14.4 percent are readmitted within 30 days. Of these, 11.9 percent were the result of preventable conditions such as pneumonia, urinary tract infections, uncontrolled diabetes and a range of cardiovascular conditions.
Geographically, readmission rates are highest in the southeast and Mid-Atlantic region and the U.S. territories (Puerto Rico and the Virgin Islands). Demographically, rates are higher among women, African-Americans and elderly patients. Medically, rates are highest among those with histories of cardiovascular–related conditions including congestive heart failure, heart attack, diabetes and renal failure. Results suggest that targeting these high-risk groups with more intensive transition-of-care programs following a stroke may help reduce readmission rates.
“If readmissions are to be used as an indicator of quality of care, it is important to differentiate preventable readmissions from those that may not be preventable,” says Lichtman, “especially since the conditions for which a patient is readmitted may be unrelated to the stroke itself.” More research is needed to improve our understanding of factors contributing to high readmission rates for ischemic stroke patients, with the goal of identifying strategies that can effectively reduce avoidable readmissions.
“Hospitals are not responsible for the socio-economic status of the communities they serve,” says Lichtman, “but they may require support programs for community health and outpatient care for stroke patients.”
Lichtman’s research team included Erica Leifheit-Limson, Ph.D., and Sara Jones, M.P.H., both from the Yale School of Public Health; Yun Wang, Ph.D., Harvard School of Public Health; and Larry Goldstein, M.D., Duke University.