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Stroke and preventable hospitalization: Who is most at risk?

Jia H, Cowper Ripley DC, Wu SS, Vogel WB, Litt ER, Tang Y, Chen GJ. Stroke and preventable hospitalization: Who is most at risk? Federal practitioner : for the health care professionals of the VA, DoD, and PHS. 2010 Dec 1; 27(12):14-20.

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Stroke is the third most frequent hospital discharge diagnosis within VHA, and approximately 80,000 VHA patients are stroke survivors. Each year, about 11,000 veterans are hospitalized within the system with a newly acquired stroke and stroke-related diseases cost the VHA over $1 billion. No study, however, report has systematically examined preventable hospitalization among patients with stroke diagnosis. The objectives of this study were: (1) to define 12-month post-stroke preventable hospitalization use by a national sample of VHA enrollees with acute stroke and (2) to assess whether the odds of using a preventable hospitalization can be explained by observed differences in patients' sociodemographic and clinical characteristics. This retrospective study examined preventable hospitalization use and assessed the correlative risks of inpatient service use by VHA stroke patients. The study included all VHA enrollees diagnosed with acute stroke in Calendar Year (CY) 2001 and CY-2002 who survived 12 months post index stroke. Preventable hospitalization conditions defined by the Institute of Medicine were modified by adding secondary ischemic stroke diagnoses to the list. A logistic regression model was fitted to estimate the impact of potential risk factors on the use of preventable hospitalization. Among the study cohort (N = 7,224), 11.5% had at least one time use of preventable hospitalization during the 12 months post-stroke follow-up period. Major medical conditions contributing to the utilization included: ischemic stroke, congestive heart failure, urinary infection, pneumonia, and chronic obstructive pulmonary disease. Logistic regression results showed that being older, African American, high priority ranking for VHA care, a frequent user of pre-stroke inpatient care, a post index stroke nursing home resident, having more comorbid conditions, and living closer to VHA facility increased the odds of preventable hospitalization use. These findings suggest that continuing effort is needed in enhancing patients' secondary stroke prevention, comorbidity monitoring, and accessibility to timely and effective ambulatory care post-stroke to reduce preventable hospitalization use by the stroke patients and to reduce VHA healthcare costs. Further study is necessary to evaluate the influence of VHA's recent transition from acute care to patient-centered ambulatory care on preventable hospitalization use by VHA stroke patients. This study is a part of the continuous effort for this research team to improve the poststroke care and functional recovery in the VHA stoke survivors.

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