Incidence and Factors Associated with Unplanned Hospital Admissions in Acute Stroke and Transient Ischemic Attack Patients Within the First Year After Discharge
Article Sidebar
Main Article Content
Abstract
Background: Stroke is a common disease. After being discharged from the Stroke Unit, some patients had unplanned hospital admissions. The effects caused stress to patients, caregivers, and medical personnel. In addition, resource waste and increased healthcare costs occurred. This research aimed to study the incidence and factors associated with unplanned hospital admissions to develop a potential healthcare and prevention patient care protocol.
Methods: A retrospective cohort study reviewed the medical records of 290 stroke patients discharged from Chiangrai Prachanukroh Hospital between 1 October 2020 and 30 September 2021. Basic data included frequency, percentage, mean, standard deviation, median, and interquartile range. Associated factors were analyzed using multivariable logistic regression analysis.
Result: Two hundred and ninety primarily male patients with an average age of 62.62±13.16 years were evaluated. The incidence of unplanned hospital admissions within one year was 24.83% (95%CI: 19.43-31.27). Significant factors were the groups of totally dependent patients. Barthel activities of daily living (ADL) 0-4 points (p = 0.007), severe dependence (ADL) 5-11 points (p = 0.035), and patients having complications during treatment from pneumonia (p = 0.047). Furthermore, unplanned hospital admissions tends to be associated with patients having a urinary catheter before discharge from the hospital (aOR 4.85, p = 0.103).
Conclusions: Stroke patients with total dependence, severe dependence, and complications during treatment from pneumonia were associated with unplanned hospital admissions within one year. This group of patients should receive comprehensive stroke care, especially in the first 180 days after discharge (intermediate care).
Keywords: stroke, unplanned hospital admissions, total dependence, severe dependence, pneumonia
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The content and information in articles published in the PCFM journal are solely the opinions and responsibilities of the authors. The journal's editorial board does not necessarily agree with or share any responsibility for them.
All articles, information, content, images, etc., published in the PCFM journal are the copyright of the PCFM journal. If any individual or organization wishes to reproduce, distribute, or use any part or the entirety of the content, they must obtain written permission from the PCFM journal beforehand.
References
Crocco AJ, Goldstein JN. Stroke. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen’s emergency medicine: Concept and clinical practice. Philadelphia: Elsevier Saunders. 2014;8:363-74.
สถิติสาธารณสุข พ.ศ. 2563. กองยุทธศาสตร์และแผนงาน กระทรวงสาธารณสุข. 2564. หน้า 76.
Hanchaiphiboolkul S, Poungvarin N, Nidhinandana S, Suwanwela NC, Puthkhao P, Towanabut S, et al. Prevalence of stroke and stroke risk factors in Thailand: Thai Epidemiologic Stroke (TES) study. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2011;94:427-36.
Weiss AJ, Jiang HJ. HEALTHCARE COST & UTILIZATION PROJECT User Support [Internet]. 2021 [cited 2023 Aug 20]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb278-Conditions-Frequent-Readmissions-By-Payer-2018.jsp
Tay MRJ. Hospital readmission in stroke survivors one year versus three years after discharge from inpatient rehabilitation: Prevalence and associations in an Asian cohort. J Rehabil Med. 2021 Jun 17;53(6):jrm00208. PubMed PMID: 34096610
Abreu P, Magalhães R, Baptista D, Azevedo E, Silva MC, Correia M. Readmissions and mortality during the first year after stroke-data from a population-based incidence study. Front Neurol. 2020;24:11:636. PubMed PMID: 32793092
Zhong W, Geng N, Wang P, Li Z, Cao L. Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: A systematic review and meta-analysis. Neurolo Sci. 2016;37:1195-202.
Qian F, Fonarow GC, Smith EE, Xian Y, Pan W, Hannan EL, et al. Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2013;6:284-92.
Depalma G, Xu H, Covinsky KE, Craig BA, Stallard E, Thomas J 3rd, Sands LP. Hospital readmission among older adults who return home with unmet need for ADL disability. Gerontologist. 2013;53:454-61.
Courtney MD, Edwards HE, Chang AM, Parker AW, Finlayson K, Bradbury C, Nielsen Z. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. J Eval Clin Pract. 2012;18:128-34.
Grossmann I, Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, et al. Stroke and pneumonia: Mechanisms, risk factors, management, and prevention. Cureus. 2021;13:e19912. PubMed PMID: 34984111
DeAlba I, Amin A. Pneumonia readmissions: risk factors and implications. Ochsner J. 2014;14:649-54.
Fang YY, Ni JC, Wang Y, Yu JH, Fu LL. Risk factors for hospital readmissions in pneumonia patients: A systematic review and meta-analysis. World J Clin Cases. 2022;10:3787-800.
Poisson SN, Johnston SC, Josephson SA. Urinary tract infections complicating stroke: mechanisms, consequences, and possible solutions. Stroke. 2010;41(4):e180-4. PubMed PMID: 20167905
Babich T, Eliakim-Raz N, Turjeman A, Pujol M, Carratalà J, Shaw E, et al. Risk factors for hospital readmission following complicated urinary tract infection. Sci Rep. 2021;11:6926. PubMed PMID: 33767321
Duncan PW, Bushnell C, Sissine M, Coleman S, Lutz BJ, Johnson AM, et al. Comprehensive stroke care and outcomes. Stroke. 2021;52:385-93.
อมรรัตน์ กุลทิพรรธน์, วัชราภรณ์ โต๊ะทอง, จีระกานต์ สุขเมือง. การพัฒนารูปแบบการดูแลผู้ป่วยโรคหลอดเลือดสมองแบบครบวงจรเครือข่ายโรงพยาบาลเพชรบูรณ์. วารสารวิชา การแพทย์. 2560;31:619-29.
Kilkenny MF, Dalli LL, Kim J, Sundararajan V, Andrew NE, Dewey HM, et al. Factors associated with 90-day readmission after stroke or transient ischemic attack. Stroke. 2020;51:571-8.
Ono T, Tamai A, Takeuchi D, Tamai Y. Factors related to readmission to a ward for dementia patients: Sex differences. Psychiatry Clin Neurosci. 2011;65:490-8.
