Relationship between early follow-up and readmission within 30 and 90 days after ischemic stroke
Relationship between early follow-up and readmission within 30 and 90 days after ischemic stroke
复制标题
DOI：
10.1212/wnl.0000000000009135
复制
发表时间：
2020-03-24
期刊：
影响因子：
9.9
通讯作者：
Simpson, Jennifer R.
中科院分区：
文献类型：
--
作者：
Leppert, Michelle H.;Sillau, Stefan;Simpson, Jennifer R.
目的探讨初级保健或神经科的早期随访是否与急性缺血性卒中入院后 30 至 90 天内较低的全因再入院率相关。方法我们使用 PharMetrics（2009 年至 2015 年美国受保人的全国代表性理赔数据库）对急性缺血性卒中后出院回家的患者（通过 ICD-9 和 ICD-10 代码识别）进行了回顾性队列研究。主要预测因素是门诊患者出院后 30 和 90 天内进行初级保健或神经病学随访，主要结局是全因 30 和 90 天再入院。多变量 Cox 模型用于初级保健和神经科就诊，指定为时间依赖性协变量，并根据患者人口统计数据、共病情况和中风严重程度测量进行调整。结果该队列包括 14,630 名患者。 7.3%的患者在30天内再次入院，13.7%的患者在90天内再次入院。到 30 天时，59.3% 的人进行了初级保健就诊，24.4% 的人进行了神经科就诊。初级保健随访与 30 天再入院率降低相关（风险比 [HR] 0.84，95% 置信区间 [CI] 0.72-0.98）。 90 天前的初级保健随访未达到显着性（HR 0.92，95% CI 0.83-1.03）。神经病学随访与 30 或 90 天内的再入院率减少无关（分别为 HR 1.05，95% CI；HR 1.00，95% CI）。 结论 初级保健的早期门诊随访与 30 天医院再入院率的减少相关。早期门诊随访可能是急性卒中入院后进行干预的重要机会。
ObjectiveTo examine whether early follow-up with primary care or neurology is associated with lower all-cause readmissions within 30 and 90 days after acute ischemic stroke admission.MethodsWe performed a retrospective cohort study of patients who were discharged home after acute ischemic stroke, identified by ICD-9 and ICD-10 codes, using PharMetrics, a nationally representative claims database of insured Americans from 2009 to 2015. The primary predictor was outpatient primary care or neurology follow-up within 30 and 90 days of discharge, and the primary outcome was all-cause 30- and 90-day readmissions. Multivariable Cox models were used with primary care and neurology visits specified as time-dependent covariates, with adjustment for patient demographics, comorbid conditions, and stroke severity measures.ResultsThe cohort included 14,630 patients. Readmissions within 30 days occurred in 7.3% of patients, and readmissions within 90 days occurred in 13.7% of patients. By 30 days, 59.3% had a primary care visit, and 24.4% had a neurology visit. Primary care follow-up was associated with reduced 30-day readmissions (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.72-0.98). Primary care follow-up before 90 days did not reach significance (HR 0.92, 95% CI 0.83-1.03). Neurology follow-up was not associated with reduced readmissions within 30 or 90 days (HR 1.05, 95% CI; HR 1.00, 95% CI, respectively).ConclusionEarly outpatient follow-up with primary care is associated with a reduction in 30-day hospital readmissions. Early outpatient follow-up may represent an important opportunity for intervention after acute stroke admissions.