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Title: Factors Associated With 90-Day Readmission After Stroke or Transient Ischemic Attack: Linked Data From the Australian Stroke Clinical Registry.
Austin Authors: Kilkenny, Monique F;Dalli, Lachlan L;Kim, Joosup;Sundararajan, Vijaya;Andrew, Nadine E;Dewey, Helen M;Johnston, Trisha;Alif, Sheikh M;Lindley, Richard I;Jude, Martin;Blacker, David;Gange, Nisal;Grimley, Rohan;Katzenellenbogen, Judith M;Thrift, Amanda G;Lannin, Natasha A;Cadilhac, Dominique A
Affiliation: The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Telethon Kids Institute, The University of Western Australia, WA
Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
The George Institute for Global Health, Sydney, NSW, Australia
The University of Sydney, NSW, Australia
Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
School of Population and Global Health, The University of Western Australia, Perth
Department of Public Health, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Bundoora Victoria, Australia
Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
Statistical Services Branch, Queensland Department of Health, Brisbane, Australia
Wagga Wagga Hospital, NSW, Australia
Sir Charles Gairdner Hospital, Nedlands, WA, Australia
Toowoomba Hospital, South Toowoomba, QLD, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Issue Date: Feb-2020
Date: 2019-12-11
Publication information: Stroke 2020; 51(2):571-578
Abstract: Background and Purpose- Readmissions after stroke are common and appear to be associated with comorbidities or disability-related characteristics. In this study, we aimed to determine the patient and health-system level factors associated with all-cause and unplanned hospital readmission within 90 days after acute stroke or transient ischemic attack (TIA) in Australia. Methods- We used person-level linkages between data from the Australian Stroke Clinical Registry (2009-2013), hospital admissions data and national death registrations from 4 Australian states. Time to first readmission (all-cause or unplanned) for discharged patients was examined within 30, 90, and 365 days, using competing risks regression to account for deaths postdischarge. Covariates included age, stroke severity (ability to walk on admission), stroke type, admissions before stroke/TIA and the Charlson Comorbidity Index (derived from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, [Australian modified] coded hospital data in the preceding 5 years). Results- Among the 13 594 patients discharged following stroke/TIA (45% female; 65% ischemic stroke; 11% intracerebral hemorrhage; 4% undetermined stroke; and 20% TIA), 25% had an all-cause readmission and 15% had an unplanned readmission within 90 days. In multivariable analyses, the factors independently associated with a greater risk of unplanned readmission within 90 days were being female (subhazard ratio, 1.13 [95% CI, 1.03-1.24]), greater Charlson Comorbidity Index scores (subhazard ratio, 1.11 [95% CI, 1.09-1.12]) and having an admission ≤90 days before the index event (subhazard ratio, 1.85 [95% CI, 1.59-2.15]). Compared with being discharged to rehabilitation or aged care, those who were discharged directly home were more likely to have an unplanned readmission within 90 days (subhazard ratio, 1.44 [95% CI, 1.33-1.55]). These factors were similar for readmissions within 30 and 365 days. Conclusions- Apart from comorbidities and patient-level characteristics, readmissions after stroke/TIA were associated with discharge destination. Greater support for transition to home after stroke/TIA may be needed to reduce unplanned readmissions.
DOI: 10.1161/STROKEAHA.119.026133
ORCID: 0000-0002-3375-287X
Journal: Stroke
PubMed URL: 31822248
Type: Journal Article
Subjects: comorbidity
Appears in Collections:Journal articles

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