From the Department of Neurology (M.H.L., S.S., S.N.P., J.R.S.), University of Colorado School of Medicine, Aurora; Colorado Cardiovascular Outcomes Research Group (M.H.L.), Denver; and Colorado School of Public Health (R.C.L.) and Skagg School of Pharmacy and Pharmaceutical Sciences (J.D.C.), University of Colorado Anschutz Medical Campus, Aurora.
Neurology. 2020 Mar 24;94(12):e1249-e1258. doi: 10.1212/WNL.0000000000009135. Epub 2020 Feb 20.
To examine whether early follow-up with primary care or neurology is associated with lower all-cause readmissions within 30 and 90 days after acute ischemic stroke admission.
We performed a retrospective cohort study of patients who were discharged home after acute ischemic stroke, identified by ICD-9 and ICD-10 codes, using PharMetrics, a nationally representative claims database of insured Americans from 2009 to 2015. The primary predictor was outpatient primary care or neurology follow-up within 30 and 90 days of discharge, and the primary outcome was all-cause 30- and 90-day readmissions. Multivariable Cox models were used with primary care and neurology visits specified as time-dependent covariates, with adjustment for patient demographics, comorbid conditions, and stroke severity measures.
The cohort included 14,630 patients. Readmissions within 30 days occurred in 7.3% of patients, and readmissions within 90 days occurred in 13.7% of patients. By 30 days, 59.3% had a primary care visit, and 24.4% had a neurology visit. Primary care follow-up was associated with reduced 30-day readmissions (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.72-0.98). Primary care follow-up before 90 days did not reach significance (HR 0.92, 95% CI 0.83-1.03). Neurology follow-up was not associated with reduced readmissions within 30 or 90 days (HR 1.05, 95% CI; HR 1.00, 95% CI, respectively).
Early outpatient follow-up with primary care is associated with a reduction in 30-day hospital readmissions. Early outpatient follow-up may represent an important opportunity for intervention after acute stroke admissions.
探讨急性缺血性脑卒中患者出院后 30 天和 90 天内接受初级保健或神经内科随访是否与全因再入院率降低相关。
我们使用 PharMetrics（一个 2009 年至 2015 年全美参保人群的全国代表性理赔数据库），对 ICD-9 和 ICD-10 编码确定的出院后居家的急性缺血性脑卒中患者进行了回顾性队列研究。主要预测指标是出院后 30 天和 90 天内的门诊初级保健或神经内科随访，主要结局是全因 30 天和 90 天再入院。使用多变量 Cox 模型，将初级保健和神经内科就诊指定为时间依赖性协变量，对患者人口统计学特征、合并症和脑卒中严重程度进行了调整。
该队列包括 14630 名患者。30 天内再入院率为 7.3%，90 天内再入院率为 13.7%。在 30 天内，59.3%的患者进行了初级保健就诊，24.4%的患者进行了神经内科就诊。初级保健随访与降低 30 天内再入院率相关（风险比 [HR]0.84，95%置信区间 [CI]0.72-0.98）。90 天内的初级保健随访虽有降低再入院率的趋势，但无统计学意义（HR0.92，95%CI0.83-1.03）。神经内科随访与 30 天或 90 天内再入院率降低无关（HR1.05，95%CI；HR1.00，95%CI）。
急性缺血性脑卒中患者出院后早期接受初级保健门诊随访与 30 天内医院再入院率降低相关。急性脑卒中患者出院后早期门诊随访可能是干预的重要机会。
