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. 2010 Nov;41(11):2525-33.
doi: 10.1161/STROKEAHA.110.599159. Epub 2010 Oct 7.

Predictors of hospital readmission after stroke: a systematic review

Judith H Lichtman  1 , Erica C Leifheit-Limson, Sara B Jones, Emi Watanabe, Susannah M Bernheim, Michael S Phipps, Kanchana R Bhat, Shantal V Savage, Larry B Goldstein
Affiliations

Predictors of hospital readmission after stroke: a systematic review

Judith H Lichtman et al. Stroke. 2010 Nov.

Abstract

Background and purpose: Risk-standardized hospital readmission rates are used as publicly reported measures reflecting quality of care. Valid risk-standardized models adjust for differences in patient-level factors across hospitals. We conducted a systematic review of peer-reviewed literature to identify models that compare hospital-level poststroke readmission rates, evaluate patient-level risk scores predicting readmission, or describe patient and process-of-care predictors of readmission after stroke.

Methods: Relevant studies in English published from January 1989 to July 2010 were identified using MEDLINE, PubMed, Scopus, PsycINFO, and all Ovid Evidence-Based Medicine Reviews. Authors of eligible publications reported readmission within 1 year after stroke hospitalization and identified ≥ 1 predictors of readmission in risk-adjusted statistical models. Publications were excluded if they lacked primary data or quantitative outcomes, reported only composite outcomes, or had < 100 patients.

Results: Of 374 identified publications, 16 met the inclusion criteria for this review. No model was specifically designed to compare risk-adjusted readmission rates at the hospital level or calculate scores predicting a patient's risk of readmission. The studies providing multivariable models of patient-level and/or process-of-care factors associated with readmission varied in stroke definitions, data sources, outcomes (all-cause and/or stroke-related readmission), durations of follow-up, and model covariates. Few characteristics were consistently associated with readmission.

Conclusions: This review identified no risk-standardized models for comparing hospital readmission performance or predicting readmission risk after stroke. Patient-level and system-level factors associated with readmission were inconsistent across studies. The current literature provides little guidance for the development of risk-standardized models suitable for the public reporting of hospital-level stroke readmission performance.

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Conflict of interest statement

Disclosures: The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Selection of Publications for Abstraction *Exclusions are not mutually exclusive
See this image and copyright information in PMC

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