Stroke patients receiving in-patient 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 researchers at the University of Texas Medical Branch at Galveston.
Hospital readmission for older adults within 30 days of discharge costs Medicare roughly $18 billion annually, researchers noted.
The study, available online at The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, is timely as hospitals will be financially penalized by Medicare for short-turnaround readmissions starting October 2012.
"[B]y 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," said Kenneth Ottenbacher, Director, Center for Rehabilitation Sciences, and Associate Director, UTMB Sealy Center on Aging.
Currently, more than 30 percent of stroke patients receive in-patient rehabilitation after release from acute care, Ottenbacher said in a release.
The researchers examined sociodemographic and clinical factors associated with hospital readmission in a sample of nearly 700 first-time stroke patients who received post-acute in-patient 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. These included:
● rehospitalization within three months of discharge from inpatient rehabilitation;
● sociodemographic characteristics, including age, gender, race/ethnicity, education and marital status;
● clinical measures, including comorbidity, length of rehabilitation stay, stroke type and body involvement;
● functional status;
● depression symptoms; and
● social support, to determine risk of isolation.
Of the nearly 700 stoke patients, approximately 18 percent were rehospitalized during the three months following discharge. Patients with better motor and cognitive abilities at rehabilitation discharge were less likely to be rehospitalized.
Conversely, those patients who reported more depressive symptoms and/or lower levels of social support were most likely to be readmitted.
Factors determining which kind of post-acute-care services a person with stroke receives, such as nursing home care or home health assistance, are complex and may also impact rehospitalization rates, researchers argued, which should form the basis for future study.
Researchers also said that because their study focused solely on stroke patients, the findings need to be examined in other patients to determine if the same factors offer predicative value across other conditions.