Man Shumei, Bruckman David, Tang Anne S, Uchino Ken, Schold Jesse D
Department of Neurology, Neurological Institute, Cleveland Clinic, United States; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, United States.
Center for Populations Health Research, Department of Quantitative Health Sciences, Cleveland Clinic, United States.
J Stroke Cerebrovasc Dis. 2021 Dec;30(12):106146. doi: 10.1016/j.jstrokecerebrovasdis.2021.106146. Epub 2021 Oct 11.
This study aimed to explore the association of socioeconomic status and discharge destination with 30-day readmission after ischemic stroke.
We examined 30-day all-cause readmission among patients hospitalized for ischemic stroke in states of Arkansas, Iowa, and Wisconsin in 2016 and 2017 and New York in 2016 using Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases.
Among the 52301 patients included, 51.1% were female. The 30-day readmission rates were 10.2%, 8.2%, 9.3%, 10.4%, 11.6%, and 11.2% for age group 18-34, 35-44, 45-54, 55-64, 65-74, and ≥75 years, respectively (p<0.001). In Generalized Estimating Equation analysis, patients with Medicare and Medicaid insurance were more likely to be readmitted, compared with private insurance, (adjusted Odds Ratio [aOR] 1.37, 95% CI 1.23-1.53; and aOR 1.26, 95% CI 1.09-1.45, respectively). Patients in the bottom quartile of zip code level median household income had higher 30-day readmission rate (12.4%) than those in the 2nd, 3rd and 4th quartile (10.3%, 10.1%, and 10.7%, respectively, p<0.001). Compared with those discharged home with self-care which had the lowest readmission rate (8.4%), patients who left against medical advice had the highest readmission rate (18.6%; aOR 2.23, 95% CI 1.75-2.83), followed by rehabilitation and skilled nursing facilities (13.2%; aOR 1.33, 95% CI 1.22-1.46), and home with home health care (11.3%, aOR 1.18, 95% CI 1.08-1.28).
Socioeconomic status and discharged destination affect readmission after stroke. These results provide evidence to inform vulnerable patient population as targets for readmission prevention.
本研究旨在探讨社会经济地位和出院目的地与缺血性中风后30天再入院之间的关联。
我们使用医疗成本和利用项目（HCUP）州住院数据库，对2016年和2017年在阿肯色州、爱荷华州和威斯康星州以及2016年在纽约州因缺血性中风住院的患者的30天全因再入院情况进行了检查。
在纳入的52301名患者中，51.1%为女性。18 - 34岁、35 - 44岁、45 - 54岁、55 - 64岁、65 - 74岁和≥75岁年龄组的30天再入院率分别为10.2%、8.2%、9.3%、10.4%、11.6%和11.2%（p<0.001）。在广义估计方程分析中，与私人保险相比，拥有医疗保险和医疗补助保险的患者再入院的可能性更高（调整后的优势比[aOR]分别为1.37，95%置信区间[CI]为1.23 - 1.53；以及aOR为1.26，95% CI为1.09 - 1.45）。邮政编码级别家庭收入中位数处于最低四分位数的患者30天再入院率（12.4%）高于处于第二、第三和第四四分位数的患者（分别为10.3%、10.1%和10.7%，p<0.001）。与再入院率最低（8.4%）的自理出院回家的患者相比，擅自离院的患者再入院率最高（18.6%；aOR为2.23，95% CI为1.75 - 2.83），其次是康复和专业护理机构（13.2%；aOR为1.33，95% CI为1.22 - 1.46），以及接受家庭医疗护理出院回家的患者（11.3%，aOR为1.18，95% CI为1.08 - 1.28）。
社会经济地位和出院目的地会影响中风后的再入院情况。这些结果为将脆弱患者群体作为再入院预防目标提供了依据。
