Abstract WP306: Race-Ethnic Disparities in 30-Day Readmission After Ischemic Stroke Among Medicare Beneficiaries in the Florida Puerto Rico Collaboration to Reduce Stroke Disparities (FL-PR CReSD) Study

• DOI: 10.1161/str.49.suppl_1.wp306
• Publication Date: 2018-10-08T17:54:39Z
• Authors: Hannah Gardener; Erica C Leifheit; Judith Lichtman; Kefeng Wang; Yun Wang; Carolina M Gutierrez; Maria A Ciliberti...; Chuanhui Dong; Mary Robichaux; Jose G Romano; Ralph L Sacco; Tatjana Rundek
• Keywords: Stroke

Background: 30-day readmission after ischemic stroke is an important health quality of care metric, but little known about potential race-ethnic disparities for this outcome. We examined rates and causes among Medicare beneficiaries in the NINDS-funded Florida-Puerto Rico Collaboration to Reduce Stroke Disparities (CReSD) Study. Methods: all-cause fee-for-service treated (ICD-9 433,434, 436) FL CReSD hospitals from 2010-2013. fit a Cox proportional hazards model that censored death adjusted age, sex, comorbidities assess differences readmission, identified reasons readmissions. Results: Among 16,952 unique patients (54% women, 75% white, 8% black, 15% Hispanic), was 15%. Readmission were 17.2% Blacks, 16.7% Hispanics, 14.4% Whites, 14.7% Others (p=0.003). There median 11 days between discharge first readmission. In risk-adjusted analyses, there no significant difference Blacks (hazard ratio 1.15, 95% confidence interval 0.99-1.33), Hispanics (1.00, 0.90-1.13), those other race (0.91, 0.71-1.16) compared Whites. Nearly 1 4 readmissions attributable acute cerebrovascular event: 16.6% or transient attack, 1.5% hemorrhagic stroke, 5.2% cerebral artery intervention (carotid endarterectomy stenting, endovascular). Interventions more common Whites (6.0%) (7.5%) than (1.8%) (3.8%; p=0.029). due pneumonia urinary tract infection 8.2%. Conclusions: Readmissions varied by race/ethnicity, generally occurred within two weeks hospital discharge. Our results underscore importance post-discharge transition need better secondary prevention strategies early stroke. Implementation effective hospitalization may reduce potentially preventable readmissions, particularly minority populations.