Battling Rising Readmission Rates for Stroke

  • Posted on January 30, 2019

It is predicted that an additional 3.4 million U.S. adults will have had a stroke by 2030, a 20.5% increase in prevalence from 2012. With this rising prevalence of strokes, assessment and care protocols continue to be a hot point of discussion and research.

And while significant advancements are being made in the areas like immediate acute stroke assessment and care by EMS, a new performance measurement is emerging for hospitals, centering on readmission numbers for stroke patients. Recent research shows that approximately 12% of ischemic stroke patients are readmitted within 30 days after discharge. The leading causes of readmission are respiratory diseases, such as pneumonia and influenza, urinary tract infections, and recurrent stroke.

Why Does Readmission Occur

Post-discharge care for stroke appears to be particularly complicated to evaluate, as the factors involved and the potential complications are wide-ranging. Studies have shown that a traditional transitional care model is not as effective in post-stroke care as in other cases, and that could be due to several factors.

For example, stroke often creates mild physical and cognitive deficits that are often unrecognized but that can affect the patient’s ability to take medications as prescribed. Additionally, as many as 70% of stroke survivors require assistance with activities of daily living, and many live in assisted living facilities or nursing homes. Finally, the older population often faces barriers in regards to cost of medication and access.

While there is only so much a care team can do to help the stroke survivor once he or she is discharged, there are some pre-discharge evaluations and steps that may be helpful in reducing the odds for readmission. Understanding the most common risk factors for readmission can help hospital care teams better identify, educate, communicate, and create care plans accordingly. For stroke survivors, readmission rates have been observed to be higher for patients with:

  • Increased age
  • Lower household income
  • High number of comorbidities
  • Living in a facility prior to stroke
  • Admission to non-neurology service
  • NIHSS admission score >5
  • Poor medication adherence

Conversely, lower readmission rates have been associated with the use of recanalization therapy and statins.

How to Reduce Readmission

In a recent article in American Nursing, several steps were identified that can help hospital care teams actively reduce the likelihood of readmission after stroke, such as:

  • Knowing the top readmission risk factors and customizing care plans accordingly
  • Accurately determining the appropriate post-acute level of care through biological and psychological assessments of patients and caregivers
  • Communicating patient observations to the larger interdisciplinary care team as plans are formed for discharge
  • Engaging patients and caregivers as active partners and advocates in the transition plan, and ensuring all understand the importance of the transition plan
  • Identifying and documenting transition issues and barriers early, and implementing strategies to address concerns
  • Implementing one of the emerging stroke transition care models, such as Transition Coaching for Stroke (TRACS) model, the Comprehensive Post-Acute Stroke Services (COMPASS) trial, and the Michigan Stroke Transitions Trial (MISTT)

Reducing admissions improves overall community health and can help save thousands of dollars. The estimated cost of a single ischemic stroke ranges between $19,000-$21,000, and the American Heart Association forecasted a 238% increase in the direct cost of stroke in the years 2010 to 2030.

By implementing preventative strategies, advocating for improved transition care for stroke survivors, and continuing to educate staff and patients about best practices, hospitals can help reduce the impact that readmissions are threatening to have in the years to come.

Learn more about stroke care and changes in the system by viewing the on-demand webinars, The EMS Revolution and Mission Possible: Acute Stroke Care.