Low preventable readmission rates after stroke question value of penalties

By Rob Goodier

NEW YORK (Reuters Health) - Few stroke patients are readmitted for preventable reasons within 30 days after discharge from a hospital, according to a new study.

While 14.4% of patients age 65 and older were readmitted, just 1.7% -- predominantly older people with cardiovascular comorbidities -- went back to the hospital for a preventable cause, researchers found.

"Recognizing and targeting these high-risk patients for more intensive transition-of-care programs may represent an important opportunity to reduce readmissions and cut healthcare costs," lead author Dr. Judith Lichtman of Yale School of Public Health in New Haven, Connecticut, told Reuters Health by email.

The results, published online October 30 in Stroke, may have implications for new U.S. Medicare policy proposals that would penalize hospitals for readmitted patients.

Such penalties may divert resources from other, more effective methods of reducing stroke, such as prevention, Dr. Lichtman said. They may also deter hospitals from taking on patients who are difficult to treat.

"This study confirms that older, sicker patients are more likely to be readmitted after a stroke. If the hospitals that treat the most medically complex patients -- often big teaching hospitals -- are penalized for higher readmission rates, it may create an incentive for hospitals to avoid caring for these patients. It's so important that reimbursement policies take these differences in patient complexity into account," agreed Dr. Karen Joynt at Brigham and Women's Hospital in Boston, who was not involved in the study.

Dr. Lichtman and her team searched a database of Medicare fee-for-service patients and found records for nearly 308,000 patients discharged with ischemic stroke in a one-year period. Of these, 44,379 (14.4%) had been readmitted within 30 days; 5,322 (1.7% of all discharges and 11.9% of patients who were readmitted) were for a preventable cause.

Preventable causes included unrecognized pneumonia, urinary tract infections and uncontrolled diabetes, according to criteria outlined by the Agency for Healthcare Research and Quality (AHRQ).

"More research is needed to differentiate preventable versus non-preventable conditions that contribute to readmissions," Dr. Lichtman said.

"An approach that essentially 'lumps' all readmissions together may make it more difficult for hospitals, physicians, and care providers to prioritize programs and design interventions that can have a big impact on reducing avoidable readmissions. Perhaps is would make more sense to address this complex issue by using a stratified, sequential approach. In other words, it may be more effective to differentiate and prioritize preventable readmissions instead of trying to address all readmissions as a single group," she suggested.

SOURCE: http://bit.ly/I5oPG8

Stroke 2013.

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