Abstract 17576: Readmission for Stroke and Quality of Care Among Patients Hospitalized With Transient Ischemic Attack (TIA): Findings From Get With the Guidelines (GWTG)-Stroke
Background: Patients with TIA are at increased risk for recurrent stroke, yet there is variation in the quality of care that may reduce this risk. We examined the association between receipt of TIA quality of care measures and estimated one-year ischemic stroke or TIA (IST) readmission risk.
Methods: We linked detailed in-hospital data for 58809 TIA patients >65 years of age enrolled in the GWTG-Stroke Registry from 2003 - 2008 to Medicare inpatient claims to obtain longitudinal outcomes following discharge. We used a Cox proportional hazards model that included demographics, past medical history and hospital characteristics to estimate the one-year readmission risk for ischemic stroke or TIA (defined by ICD-9 of 434.0-436.99). The predicted probability of readmission generated from this model was defined as the risk score for one-year readmission for IST. After creation of the score, we estimated receipt of a global defect-free care (DFC) measure and individual achievement measures within risk score quintiles.
Results: The overall one-year readmission rate for IST was 11.8%. Patients who were readmitted were on average older (80.1 years vs. 78.8 years), more likely to be female (62.2% vs. 60.8%), and less likely to be white (82.8% vs. 85.4%) than patients who were not readmitted. Compared with TIA patients not readmitted, readmitted patients were less likely to receive anticoagulation for atrial fibrillation (AF), statin medication for LDL-C >100 mg/dL, smoking cessation counseling, and DFC. Patients in the highest quintile of GWTG readmission for IST risk score were less likely to receive smoking cessation counseling, statins, and DFC compared to patients with the lowest estimated risk (Figure 1).
Conclusions: TIA patients with high estimated risk of readmission for IST are less likely to receive defect-free care than low-risk patients. Standardized risk assessment and delivery of optimal inpatient care for TIA are needed to reduce this risk-treatment mismatch.
- © 2013 by American Heart Association, Inc.