Inpatient rehabilitation facilities’ hospital readmission rates for medicare beneficiaries treated following a stroke

Ask your hospital what is their 100% recovery rate and their readmission rate. No knowledge, fire the board of directors. The heads up asses must be pulled out. 

Inpatient rehabilitation facilities’ hospital readmission rates for medicare beneficiaries treated following a stroke

Laura Coots Daras , Anne Deutsch , Melvin J. Ingber , Jennifer Gaudet Hefele & Jennifer Perloff

Received 08 Nov 2019, Accepted 25 Apr 2020, Published online: 11 Jul 2020

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• https://doi.org/10.1080/10749357.2020.1771927
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ABSTRACT

Background

Stroke is the leading cause for admission to the nearly 1,200 Inpatient Rehabilitation Facilities (IRFs) nationally in the US. For many patients, post-acute care is an important component of their rehabilitation. Several quality measures have been publicly reported for post-acute care providers, including hospital readmissions. However, to date none have focused on specific medical conditions, limiting the usability for patients and quality improvement.

Objective

To assess hospital readmission rates for Medicare patients receiving inpatient rehabilitation following stroke and to identify risk factors in order to evaluate the feasibility of a stroke-specific hospital readmission measure.

Methods

Observational study analyzing national Medicare inpatient claims and administrative data to assess hospital readmissions. Using logistic regression, we calculated unadjusted and risk-standardized readmission rates, which adjusted for patient characteristics, including type of stroke and admission function, to capture stroke severity.

Results

Our national study included 116,073 fee-for-service Medicare beneficiary discharged from IRFs in 2013–2014 following stroke from 1,162 IRFs nationally. The observed hospital readmission rate among IRF patients following stroke was 11.6% and varied by patients’ admission motor function. Patients with greater functional dependence had higher readmission rates on average. Lower admission function, hemorrhagic and other stroke types (relative to ischemic) were significantly associated with higher odds of hospital readmission.

Conclusion

Results suggest it is feasible to assess hospital readmission rates among a stroke-cohort treated in IRFs. Stroke-focused quality measures would be useful to patients in selecting a provider and for providers in evaluating their stroke rehabilitation program outcomes. Secondary results suggest that admission function (FIM) capture stroke severity, a limitation with other claims-based stroke measures.

Causes of interruption of acute rehabilitation and readmission after stroke

So the end result should have been to go back to the original hospital where treated and have them explain what they are doing to prevent these recurrent strokes/readmissions with 100% accuracy.  That is what a responsible and excellent hospital would be doing. The board of directors should fire all involved if that isn't occurring. I take no prisoners in trying to identify what needs to be done for solving stroke. You need no medical knowledge to attack this management problem.

Causes of interruption of acute rehabilitation and readmission after stroke

Amanda Herrmann, Sally Othman, Sarah Jamal, Haitham Hussein

First published April 9, 2019,

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Abstract

Objective: The goal of this project was to identify the main causes of unplanned readmission of stroke patients from inpatient rehabilitation to a surgical or medical unit.

Background: Stroke patients admitted to inpatient rehabilitation must meet certain functional and clinical criteria, therefore, the reasons for readmission maybe different from those reported for all stroke discharges.

Design/Methods: Using prospectively maintained database of our CARF-accredited stroke rehabilitation program, patients with diagnosis of stroke (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) who were discharged to acute care hospitals were identified. We excluded patients who were readmitted for planned surgery/procedure. Patient characteristics were extracted from the database and retrospective chart review.

Results: We identified 101 stroke patients who had an unplanned readmission (age 64±15 years; 38% female; 72% were white). Of these patients, 73 initially suffered from an ischemic stroke, 24 hemorrhagic stroke, and 4 patients had unknown stroke type. The median (IQR) Functional Independence Measure score was 55 (38–68). The 3 most common causes of readmission were recurrent/worsening stroke (n=21), cardiac (n=20), and infection (n=12). There was no difference between ischemic and hemorrhagic stroke in LOS 8.9±5.7 vs 9.7±9 days (t test p=0.5), however, the distribution of readmission reasons was different with DVT/PE more frequent in hemorrhagic stroke while cardiac reasons more frequent in ischemic stroke (fisher exact test p=0.02 for both). The median length of stay second admission was 5 (3–8) days after which only 39 returned to inpatient rehab, 18 went straight to home, 13 transferred to TCU, 9 went to nursing home, and 17 died.

Conclusions: Several reasons of transfer from inpatient rehabilitation to acute care are predictable and preventable especially that these patients are under direct medical supervision.

Structured transitional stroke care could decrease hospital readmission rates

And I bet that stopping the neuronal cascade of death in the first week would do more than any after the fact interventions to reduce readmission rates. But we seem to have no one in stroke that has a functioning brain.
http://www.news-medical.net/news/20160429/Structured-transitional-stroke-care-could-decrease-hospital-readmission-rates.aspx

A transitional stroke clinic developed by doctors and nurse practitioners at Wake Forest Baptist Medical Center reduced 30-day readmission rates by 48 percent, according to a study published in the April 28 online issue of the journal Stroke.
The study's goal was to determine if a structured transitional stroke clinic led by nurse practioners could reduce 30-day and 90-day hospital readmission rates.
"The needs of patients discharged directly home after suffering a stroke are often complex," said Cheryl Bushnell, M.D., director of the Stroke Center at Wake Forest Baptist and lead author of the study.
"Patients are faced with physical and cognitive limitations, complex medication regimens, new diagnoses of chronic conditions and lack of social support. These barriers challenge independence and stroke recovery and leave patients at high risk for readmissions."

The study evaluated 510 stroke or transient ischemic attack patients who had been discharged to their homes over a three-year period. The Wake Forest Baptist transitional care model included follow-up phone calls within a week of discharge and follow-up clinic visits within two to four weeks of discharge.
The researchers found that a visit to the stroke clinic was associated with a 48 percent lower risk of 30-day readmissions compared to patients who did not attend the follow-up clinic visit. A clinic visit did not affect 90-day readmission rates. A limitation of the study was that only readmissions at Wake Forest Baptist were included.
"A lot of stroke programs are doing follow-up phone calls to patients, but our data shows that phone calls alone are not good enough to reduce readmissions," Bushnell said. "It is really important for patients to be engaged in their own stroke recovery, and part of that involves coming to clinic and making sure they get all the services they need."
Bushnell also said that primary care doctors caring for stroke patients should be alert to changes that are hallmarks of stroke: patients not thinking as clearly as they used to, memory problems, limited ability to use their hands or overall mobility issues, as well as depression and social isolation.
"We are at the forefront of a trend that really emphasizes the initial transition phase in post-stroke care," Bushnell said. "The next steps include expanding our model to include community services and individualized electronic-care plans."

Source:

Wake Forest Baptist Medical Center