Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke.
Association Between Early Outpatient Visits and Readmissions After Ischemic Stroke.
复制标题
DOI：
10.1161/circoutcomes.117.004024
复制
发表时间：
2018-04
期刊：
影响因子：
--
通讯作者：
Burke JF
中科院分区：
文献类型：
--
作者：
Terman SW;Reeves MJ;Skolarus LE;Burke JF
减少再入院是优化卒中后护理和降低成本的重要目标。早期门诊随访可能是减少再入院的一个重要策略。我们检查了首次门诊接触时间和再入院之间的关系，以告知出院后的过渡。我们对2012年所有经ICD-9-CM编码识别的急性缺血性中风出院的医疗保险服务收费患者进行了回顾性队列研究。我们的主要预测变量是患者是否在出院后30天内进行了初级保健或神经病学访问。我们的主要结局变量是30天全因再入院。我们使用单独的多变量Cox模型，将初级保健和神经病学就诊指定为时间相关协变量，并根据许多患者和系统层面的因素进行调整。该队列包括78,345例患者。分别有61%和16%的患者在出院后30天内进行了初级保健和神经病学访问。对于初级保健和神经病学，分别在出院后的中位（IQR） 7（4-13）天和15（5-22）天就诊。9.4%的患者在30天内再次入院。出院后中位14 （IQR 7-21）天再入院。出院后30天内就诊的患者再入院的调整风险略低于未就诊的患者（HR 0.98, 95% CI 0.97-0.98）。在30天的神经内科就诊中，这种关联几乎相同（HR 0.98, 95% CI 0.97-0.98）。30天的门诊随访与出院的老年中风患者再入院率的小幅下降有关。进一步的工作应该评估如何改善门诊护理以进一步减少再入院。
Reducing hospital readmission is an important goal to optimize post-stroke care and reduce costs. Early outpatient follow-up may represent one important strategy to reduce readmissions. We examined the association between time to first outpatient contact and readmission to inform post-discharge transitions. We performed a retrospective cohort study of all Medicare fee-for-service patients discharged home after an acute ischemic stroke in 2012 identified by ICD-9-CM codes. Our primary predictor variable was whether patients had a primary care or neurology visit within 30 days of discharge. Our primary outcome variable was all-cause 30-day hospital readmission. We used separate multivariable Cox models with primary care and neurology visits specified as time-dependent covariates, adjusted for numerous patient- and systems-level factors. The cohort included 78,345 patients. Sixty-one percent and 16% of patients, respectively, had a primary care and neurology visit within 30 days of discharge. Visits occurred a median (IQR) 7 (4–13) and 15 (5–22) days after discharge for primary care and neurology, respectively. Thirty-day readmission occurred in 9.4% of patients. Readmissions occurred a median 14 (IQR 7–21) days after discharge. Patients who had a primary care visit within 30 days of discharge had a slightly lower adjusted hazard of readmission than those who did not (HR 0.98, 95% CI 0.97–0.98). The association was nearly identical for 30-day neurology visits (HR 0.98, 95% CI 0.97–0.98). Thirty-day outpatient follow-up was associated with a small reduction in hospital readmission among elderly stroke patients discharged home. Further work should assess how outpatient care may be improved to further reduce readmissions.