Patients who are readmitted to the hospital within 30 days of being discharged are said to have experienced a hospital readmission. Rehospitalization can be a costly and disruptive experience for patients, and can lead to poorer health outcomes. Patients who are well informed about their health conditions and treatments are less likely to be readmitted to the hospital. Patients who are readmitted to the hospital are often those who do not understand their discharge instructions, or who have inadequate support at home. Informed patients are more likely to take their medications as prescribed, follow up with their doctors, and make healthy lifestyle choices. Patients who are readmitted to the hospital can incur significant costs, both financial and emotional. Readmissions are often preventable, and patients can play a role in preventing them by being informed and engaged in their own care.
Retrival costs a high percentage of health care dollars, as well as negatively impacting patient outcomes. While the cause of readmissions is variable, the rate varies greatly by institution. In the past, nearly 20% of Medicare discharges resulted in a return to the hospital within 30 days.
Are Hospital Readmissions Preventable?
A hospital readmission is defined as an admission to the hospital within 30 days of a previous discharge. Approximately one in every five Medicare patients is readmitted to the hospital within 30 days of discharge. Readmissions are costly, both financially and in terms of the patient’s health and well-being. While some readmissions are unavoidable, many are preventable. There are many strategies that have been shown to reduce readmissions. These include improved transitions of care, better discharge planning, patient education, and follow-up after discharge. Improved transitions of care involve making sure that the patient’s primary care physician and other providers are aware of the discharge and have the information they need to provide continuity of care. Discharge planning involves making sure that the patient has the resources and support they need to successfully recover at home. This includes making sure that the patient has transportation to follow-up appointments, sufficient medication, and access to home health services if needed. Patient education is important in preventing readmissions because it empowers patients to take an active role in their recovery and become partners in their care. Follow-up after discharge is also crucial in preventing readmissions. While readmissions are costly and often preventable, they are still a reality for many patients. However, by implementing the strategies mentioned above, hospitals and providers can make a significant impact in reducing readmissions and improving the quality of care for their patients.
After a stroke, Taiwan hospitals are frequently cited for preventable hospital readmissions. A stroke is more likely to cause a patient to be readmitted to the hospital once they are discharged. During the initial hospital stay, there may be events or conditions that lead to an admission. It is possible to improve stroke care by developing discharge planning and post-acute care programs. Events that could have been avoided if better hospital care, community care, and/or home care had been provided are referred to as mission events. Infection, recurrent ischemic stroke, and other cardiovascular events were the most common causes of readmission. Patients who were readmitted early had shorter stays in the hospital, poorer physical function, and higher frequencies of atherosclerotic stroke.
Despite the lack of national data, it is unclear how frequently patients are re-hospitalized after strokes. We used data from Taiwan’s National Health Insurance (NHI) in the 2005 Health Insurance Database (LHID 2005; see notes for further details). The total population of Taiwan is represented by a national representative sample of one million people. Because there was no identifiable personal information contained within the database, informed content was not permitted to be provided. Excluding sex and age, there were also correlations between the number of strokes, the length of stay (LOS), the type of stroke (i.e., ischaemic stroke, intracerebral hemorrhage, or other), and the severity of the stroke. The NHI premium paid by each patient was used as a proxy for income, hospital level, ownership, and region, and urbanization. Using a randomized, multinomial logistic regression model, the association of related factors and readmissions was determined.
Within 30-days, the mean LOS was 11.51 (SD = 9.59) for PPR, and 11.25 (SD = 9.75) for non-PPR, and within one year, the mean LOS was 18.26 (SD = 22.97) for ppro, and 19. Compared to no readmissions, patients aged 45 to 64, 65 to 69, 70 to 79, and 80 years old had an OR of 1.29, 1.43, and 1.51 for 30-day PPR, and 2.57, 3.6, and 3.37 for 1-year. Among the significant factors, one patient was treated with PPR at a rate of 80 percent, two patients had a monthly income of 19,700–22,700, and one patient had a monthly income of 21,900–21,900. 30 days after completion, CCI levels of 7 or higher were associated with a significantly higher rate of readmission (OR 1.84, 95% CI [1-2.09], OR 3.69). Within one year of being diagnosed, all types of stroke, as well as all age groups, as well as urbanization, had a significant impact on the patient’s return to health. As a result of these variables, male, hospitalization year, monthly income, and treatment in the central area of Taiwan were all significantly related to readmission. According to Mittal et al.,
43 (7.6%) of 537 patients who had acute ischemic stroke (AIS) were readmitted within 30 days of their hospitalization, with 2.8% having post-stroke pulmonary hypertension (PPR). According to a recent study conducted at a Hong Kong geriatric center, only 15% of 79 unplanned readmissions (19%) were preventable. According to research, certain patient characteristics such as age and socioeconomic status can be used to predict whether a stroke patient will need to be readmitted. Based on previous research32,36, the impact of hospital level on short-term and long-term readmissions was consistent. The implementation of the Post Acute Care (PAC) program in Taiwan may have contributed to the lower rate of PPR for district hospitals. If left untreated, the short-term effects of LOS may be attributed to incomplete treatment during index hospitalization. When stroke patients are treated at a regional, public, or private hospital, their chances of experiencing a stroke are highest.
They are also more likely to live in poorer areas of the country. In the long-term, long-term PPR was found to have lower ORs than no readmission, and we believe this is due to Taiwan’s implementation of the national health insurance post-acute care program in 2014. By adjusting Long Term Care to 2.0, stroke patients may benefit from lower readmission rates. The combination of discharge planning and post-discharge follow-up programs, as well as increased use of social determinants of health, is likely to result in a significant decrease in the number of PPR among these patients. The findings of a separate predictive model of death or potentially avoidable readmission may differ, so it is critical for researchers to investigate this separately. Death and hospitalization after acute ischemic stroke: 5-year follow-up of Medicare patients. Cerebrovasc is a well-known stroke disease. (
2015) “‘The Making of a Computer’ by Google Scholar van Walraven.” The measurement and prevention of potentially avoidable hospital readmissions. Hong Kong Med. 16(5), 383-389 (2010), doi:10.1542/hmol.2010. The study analyzed 30-day hospital readmissions for acute ischemic stroke patients based on a population study. In the project, C. Y., Hung, Y., and Chuang, L., develop a large-scale health interview survey that incorporates development stratification in Taiwan townships. Mortality and rehospitalization in hospitals differ based on the region in which they are located.
The study was funded by the Ministry of Science and Technology, Taiwan (MOST 105-2410-H-009-012 -SS2) and the Ling-Jan Chiou Institute of Hospital and Health Care Administration, National Yang Ming Chung University, Taiwan. Thank you, Chih-Wen Chang, for your efforts in data management and analysis. This article may be used, shared, adapted, distributed, and reproduced in any medium or format under the Creative Commons 4.0 International License. You must credit the original author(s), as well as the source and the Creative Commons license, and indicate whether or not changes have been made.
In this study, a large proportion (18%) of readmissions (18%) occur within 90 days of discharge. Over half of these readmissions (140 of 269 cases, 52.0%) could be attributed to “gaps in care” during the initial inpatient stay. In most cases, this refers to patients being discharged prematurely without receiving the necessary medical attention. Public insurance policies have a higher risk of potentially preventable hospitalization than private insurance policies. Although private insurance may provide some advantages, public insurance is more likely to be the best option overall because it ensures that patients receive necessary care and interventions to prevent them from returning to the hospital.
