Relationship between early follow-up and readmission within 30 and 90 days after ischemic stroke. (24th March 2020)

• Record Type: Journal Article
• Authors: Leppert, Michelle H.; Sillau, Stefan; Lindrooth, Richard C.; Poisson, Sharon N.; Campbell, Jonathan D.; Simpson, Jennifer R.
• Is Part Of: Neurology. Volume 94:Number 12(2020)
• Publication Date: 2020-03-24
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000009135
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Objective: 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. Methods: 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. Results: 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). Conclusion: 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.