Stroke patients receiving inpatient rehabilitation are more likely to land back in the hospital within three months if they are functioning poorly, show signs of depression and lack social support, according to a study.
The researchers said their findings are timely because Medicare will hold hospitals accountable for high short-turnaround readmission rates beginning in October.
“By identifying clear demographic, clinical and environmental factors that lead to rehospitalization, we can develop meaningful quality indicators for post-acute care that target ways to improve patients health and contain costs by reducing the likelihood of readmission,” Kenneth Ottenbacher, PhD, director of the Center for Rehabilitation Sciences and associate director of the Sealy Center on Aging at the University of Texas Medical Branch at Galveston, said in a news release.
More than 30% of stroke patients receive inpatient rehabilitation after release from acute care, Ottenbacher said.
“Though we intuitively know that these patients are at highest risk for being rehospitalized especially if they are depressed, isolated or lack independence the data to support this did not exist prior to our study,” Ottenbacher said. Most previous studies on readmissions used Medicare data, which by design focuses on payment rather than patient data, he added.
The researchers examined sociodemographic and clinical factors associated with hospital readmission in a sample of nearly 700 first-time stroke patients. Each had received post-acute inpatient rehabilitation between 2005 and 2006 at nine facilities in eight states and the District of Columbia. Data were collected via discharge follow-up interviews conducted by each facility within 72 hours of release and again three months later.
Data from the interviews included rehospitalization within three months of disharge from inpatient hospitalization; sociodemographic characteristics, including age, gender, race/ethnicity, education and marital status; clinical measures, including comorbidity, length of rehabilitation stay, stroke type and body involvement (right, left, bilateral); functional status, such as activities related to self care, communication, social cognition, mobility and control of bodily status; depression symptoms; and social support, to determine risk of isolation.
Of the nearly 700 stoke patients, approximately 18% were rehospitalized during the three months following discharge. Patients with better motor and cognitive abilities at rehabilitation discharge were less likely to be rehospitalized. Those reporting more depressive symptoms and/or lower levels of social support were most likely to be readmitted.
Ottenbacher identified social support as one of the most important predictors identified. It can be factored into discharge plans and used to identify patients who could benefit from services designed to prevent hospital readmission, such as home health services. The finding is significant because information on patients social support is not currently included in data sets that could influence health policy, he said.
In white patients, signs of depression increased the risk of rehospitalization by 21%. However, minorities with depressive symptoms had a 5% lower risk of being readmitted. The difference was diminished when the researchers adjusted their analyses to account for racial and ethnic variables, such as disease comorbidity, and the studys small sample size of minority patients.
“Though the disparity did not hold up in our study after adjusting for sample size, we were surprised by the preliminary finding and believe it is an important topic for future research in a large minority population,” Ottenbacher said.
Factors determining which kind of post-acute-care services a person with stroke receives, such as nursing home care versus in-home assistance, are complex and may also affect rehospitalization rates — another aspect Ottenbacher plans to include in future research. Finally, he noted that because this study focused on stroke patients only, the findings need to be examined in other patients to determine whether the same factors offer predictive value across other conditions.
The study is available on the website of The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.