Readmission within 1 month of discharge among patients with acute ischemic stroke: results of the University HealthSystem Consortium Stroke Benchmarking study

Abstract

Background: The University HealthSystem Consortium (UHC) recently conducted a benchmarking
project to identify variations in processes of care and clinical resource management, identify new patterns
in practice, and distinguish opportunities for improvement among UHC hospitals.
Methods: We performed this analysis to determine the rate of and factors associated with readmission
within 1 month of discharge among patients with acute ischemic stroke. A retrospective review of 40 consecutive ischemic stroke cases meeting inclusion criteria and discharge between January 1st and June 30th,
2004 was conducted in 32 hospitals. We performed a multivariate analysis to identify demographic and
clinical factors associated with readmission among patients with ischemic stroke.
Results: A total of 1018 patients (mean age 66 years, range 18–98 years), who were discharged from the
hospital and had follow-up available, were analyzed. A total of 90 (9%) of these patients were readmitted
within 1 month of discharge. Common reasons for readmission were recurrent stroke (24%), infection
(12%), chest pain or myocardial infarction (10%), worsening of stroke symptoms (7%), arrhythmias (7%),
and congestive heart failure (3%). In univariate analysis, older patients (P = 0.03) and those discharged
home without health care were more likely to be readmitted (P = 0.04). In the multivariate analysis, age
was the only predictor for readmission. For each decade older age, there was a 19% increase in odds of
readmission. Patient’s race/ethnicity, presence of cardiovascular risk factors, and severity of stroke, insurance status, neurology consultation, discharge destination were not associated with readmission.
Conclusions: In the present multicenter study, 9% of the discharged patients with ischemic stroke were
readmitted within a 1 month. Several etiologies for readmission were identified to assist in implementing
quality improvement strategies.