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Risk factors associated with 31-day unplanned readmission in 50,912 discharged patients after stroke in China
Tiancai Wen1,2,3, Baoyan Liu3, Xia Wan4
1School of Computer Science, Northwestern Polytechnical University Xi'an, Shangxi Province, 710129, China.
Insights
Unplanned readmissions after stroke are common in China, with recurrent stroke and hypertension being key causes. Factors like diabetes, clinical pathways, and discharge status significantly influence readmission risk, while insurance and longer hospital stays may reduce it.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- Unplanned readmissions within 31 days post-stroke serve as a critical metric for evaluating hospital care quality.
- This study investigates the risk factors associated with 31-day unplanned readmissions among stroke patients in China.
Purpose of the Study:
- To identify and analyze patient- and hospital-level factors contributing to 31-day unplanned readmissions after stroke in China.
- To provide insights for improving post-discharge care strategies and reducing readmission rates.
Main Methods:
- A retrospective analysis of 50,912 stroke patients from 375 hospitals across China (2015-2016) was conducted.
- Data were extracted from the Medical Record Monitoring Database, utilizing multilevel logistic modeling to assess readmission risk factors.
Main Results:
- The 31-day unplanned readmission rate was 28.8%, with recurrent stroke (34.8%) and hypertension (22.94%) as primary causes.
- Increased readmission risk was linked to diabetes, use of clinical pathways, and discharge against medical advice.
- Factors associated with lower readmission risk included basic and commercial medical insurance, older age, hemorrhagic stroke, and longer hospital stays (>7 days).
Conclusions:
- Key determinants of 31-day stroke readmissions include patient demographics (age), stroke type, insurance status, discharge disposition, clinical pathway utilization, and length of hospital stay.
- These findings highlight the complex interplay of clinical and systemic factors influencing post-stroke readmission.
- Targeted interventions addressing these factors are crucial for enhancing stroke care quality and reducing readmission burdens.
Background:
Unplanned readmission within 31 days of discharge after stroke is a useful indicator for monitoring quality of hospital care. We evaluated the risk factors associated with 31-day unplanned readmission of stroke patients in China.
Methods:
We identified 50,912 patients from 375 hospitals in 29 provinces, municipalities or autonomous districts across China who experienced an unplanned readmission after stroke between 2015 and 2016, and extracted data from the inpatients' cover sheet data from the Medical Record Monitoring Database. Patients were grouped into readmission within 31 days or beyond for analysis. Chi-squared test was used to analyze demographic information, health system and clinical process-related factors according to the data type. Multilevel logistic modeling was used to examine the effects of patient (level 1) and hospital (level 2) characteristics on an unplanned readmission ≤31 days.
Results:
Among 50,912 patients, 14,664 (28.8%) were readmitted within 31 days after discharge. The commonest cause of readmissions were recurrent stroke (34.8%), hypertension (22.94%), cardio/cerebrovascular disease (13.26%) and diabetes/diabetic complications (7.34%). Higher risks of unplanned readmissions were associated with diabetes (OR = 1.089, P = 0.001), use of clinical pathways (OR = 1.174, P < 0.001), and being discharged without doctor's advice (OR = 1.485, P < 0.001). Lower risks were associated with basic medical insurances (OR ranging from 0.225 to 0.716, P < 0.001) and commercial medical insurance (OR = 0.636, P = 0.021), compared to self-paying for medical services. And patients aged 50 years old and above (OR ranging from 0.650 to 0.985, P < 0.05), with haemorrhagic stroke (OR = 0.467, P < 0.001), with length of stay more than 7 days in hospital (OR ranging from 0.082 to 0.566, P < 0.001), also had lower risks.
Conclusions:
Age, type of stroke, medical insurance status, type of discharge, use of clinical pathways, length of hospital stay and comorbidities were the most influential factors for readmission within 31 days.
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