Internationale Zeitschrift für Physikalische Medizin und Rehabilitation
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Hospital Readmission among Stroke Patients who Received Post-Hospital Care: A Systematic Review

Janet Prvu Bettger, Brian Lupo, Kristin Nichols, Kelsy Smith, Emily Windes and Tephanie Darden-Fluker

Background: Stroke is a leading cause of death and disability in both developed and developing nations. The need for posthospital care to promote continued recovery and prevent the onset of complications is high; however, the complexities of managing a stroke can result in readmissions to the hospital. This systemic review describes the rates, predictors and causes of readmission to the hospital among stroke patients who received short-term inpatient and community-based posthospital care. Methods: Four databases were searched by the six authors to identify 102 unique citations meeting our search criteria published in English since 1997. Title and abstract screening, followed by full-text screening, was completed by pairs of authors and reconciled by a third author. Data were extracted and synthesized to answer our key questions related to hospital readmissions documented within 12 months of discharge. Results: Eleven studies including 1 systematic review of randomized controlled trials, 6 retrospective and 4 prospective cohorts met our inclusion criteria. Readmission rates ranged from 8.2% to 74.5% likely due to the heterogeneity in study design, posthospital services examined, and timing of follow-up. Few models provided rates adjusted for case-mix, model discrimination or performance, or predictors of readmission by posthospital service (or a comparison of services), and none reported causes of hospital readmission by post-hospital service. Conclusions: Available evidence suggests hospital readmissions from posthospital care are an important area for research and intervention to improve practice and guide health policy.