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. 2018 Dec 26;18(1):218.
doi: 10.1186/s12883-018-1209-y.

Risk factors associated with 31-day unplanned readmission in 50,912 discharged patients after stroke in China

Tiancai Wen  1   2   3 , Baoyan Liu  3 , Xia Wan  4 , Xiaoping Zhang  3 , Jin Zhang  3 , Xuezhong Zhou  5 , Alexander Y L Lau  6 , Yanning Zhang  7
Affiliations

Risk factors associated with 31-day unplanned readmission in 50,912 discharged patients after stroke in China

Tiancai Wen et al. BMC Neurol. .

Abstract

Background: Unplanned readmission within 31 days of discharge after stroke is a useful indicator for monitoring quality of hospital care. We evaluated the risk factors associated with 31-day unplanned readmission of stroke patients in China.

Methods: We identified 50,912 patients from 375 hospitals in 29 provinces, municipalities or autonomous districts across China who experienced an unplanned readmission after stroke between 2015 and 2016, and extracted data from the inpatients' cover sheet data from the Medical Record Monitoring Database. Patients were grouped into readmission within 31 days or beyond for analysis. Chi-squared test was used to analyze demographic information, health system and clinical process-related factors according to the data type. Multilevel logistic modeling was used to examine the effects of patient (level 1) and hospital (level 2) characteristics on an unplanned readmission ≤31 days.

Results: Among 50,912 patients, 14,664 (28.8%) were readmitted within 31 days after discharge. The commonest cause of readmissions were recurrent stroke (34.8%), hypertension (22.94%), cardio/cerebrovascular disease (13.26%) and diabetes/diabetic complications (7.34%). Higher risks of unplanned readmissions were associated with diabetes (OR = 1.089, P = 0.001), use of clinical pathways (OR = 1.174, P < 0.001), and being discharged without doctor's advice (OR = 1.485, P < 0.001). Lower risks were associated with basic medical insurances (OR ranging from 0.225 to 0.716, P < 0.001) and commercial medical insurance (OR = 0.636, P = 0.021), compared to self-paying for medical services. And patients aged 50 years old and above (OR ranging from 0.650 to 0.985, P < 0.05), with haemorrhagic stroke (OR = 0.467, P < 0.001), with length of stay more than 7 days in hospital (OR ranging from 0.082 to 0.566, P < 0.001), also had lower risks.

Conclusions: Age, type of stroke, medical insurance status, type of discharge, use of clinical pathways, length of hospital stay and comorbidities were the most influential factors for readmission within 31 days.

Keywords: Cover sheet of medical record; Hospitalization; Risk factor; Stroke; Unplanned readmission.

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Conflict of interest statement

Ethics approval and consent to participate

The ethics committees at Institute of Basic Research in Clinical Medicine at China Academy of Chinese Medical Sciences approved this study (Reference number: 2016NO.11–01) on November 7, 2016. The China Academy of Chinese Medical Sciences granted administrative permission to access the raw data from the Medical Record Monitoring Database.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart for patient selection
Fig. 2
Fig. 2
The distribution of included patients across China. Number of patients
Fig. 3
Fig. 3
Reasons for readmissions. Percent
Fig. 4
Fig. 4
The proportions for patients readmitted ≤31 days after discharge due to a stroke-related condition in different age groups with different diseases. Readmitted ≤31 days. Readmitted > 31 days
See this image and copyright information in PMC

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