A retrospective study suggests that functional status, rather than medical comorbidities, is a stronger factor determining the likelihood of hospital readmission after a stroke.
In the study, published recently in PLOS ONE, researchers from Spaulding Rehabilitation Hospital and Harvard Medical School examined records from 803,124 stroke patients in the Uniform Data System for Medical Rehabilitation database who were admitted to inpatient rehabilitation facilities between 2002 and 2011, according to a media release from Spaulding Rehabilitation Network.
For the study, logistic regression models based on function and gender were developed to predict the odds of 3-, 7-, and 30-day readmission from inpatient rehabilitation facilities to acute care hospitals for stroke patients. These function-based models were compared with models based instead on comorbidities and age. Additionally, comorbidities were added to the function-based models to determine whether this improved model predictive ability, the release explains.
Functional status was measured by a validated, standardized assessment—the Functional Independent Measure (FIM). Comorbidities were assessed using three different comorbidity measures (the Elixhauser index, Deyo-Charlson index and Medicare comorbidity tier system).
Model performance was assessed using c-statistics, a statistical test used to assess the ability of the model to predict patients that require readmission to the acute care hospital. For 3-, 7-, and 30-day readmissions, models based on function and gender (c-statistics 0.701, 0.672, and 0.682, respectively) performed significantly better than even the best-performing models based on comorbidities and age (c-statistics 0.577, 0.574, 0.584, respectively).
Furthermore, the addition of comorbidities to function-based models did not appreciably improve model performance (c-statistic differences of only .011, 0.011, and 0.012 for 3-, 7-, and 30-day readmissions, respectively, for the best-performing models), the release continues.
“These study results continue to build the case that functional status should be a major factor used to determine the likelihood of readmissions,” says principal investigator Jeffrey Schneider, MD, medical director, Burn and Trauma Rehabilitation Program at Spaulding Rehabilitation Hospital, and assistant professor at Harvard Medical School, in the release.
“It is incumbent on the medical community to ensure that any possible setbacks such as readmissions that can be prevented be identified to ensure stroke survivors can reach their maximum potential for quality of life,” Schneider adds.
[Source: Spaulding Rehabilitation Network]