LAUSR

Introduction: Reducing readmission rate is a healthcare priority. The aim of this project is to examine factors associated with readmission after stroke in a privately insured cohort. Methods: Our organization is a health insurance provider as well as a healthcare provider. We retrospectively identified members of our insurance plan who discharged from one of our family of hospitals (one comprehensive stroke center, one primary stroke center, and two stroke ready hospitals) 2014-2018 with a stroke diagnosis. Using insurance claims, we captured all readmissions and ER visits in the 30 days after discharge. Using the same data, we were also able to identify primary care visits in the year preceding and the month following the index stroke. The impact of primary care was examined in a univariate analysis and a multivariate analysis adjusting for age, sex, race, stroke type, and length of stay (LOS). Results: We identified 1177 patients after excluding those who were not members of our insurance plan and those who had a planned admission such as to inpatient rehab (mean age 71±15 years; 53% women; 17% non-white). Stroke types were 72% ischemic stroke; 12% TIA; 7% ICH; 4% SAH. Most common discharge destination was home 68% followed by skilled nursing facility 27%. Overall 30-day all-cause readmission rate was 31% (21% inpatient admission, 8% ER visit, and 2% both). In an unadjusted model, there was a significant association between number of primary care visits and probability of readmission (OR 0.60 [95% CI 0.50-0.72]; p<0.0001). This association remained significant in the multivariate analysis (OR 0.73 [95% CI 0.58-0.91]; p=0.005). Other variables independently associated with readmission include age, LOS, and ischemic type of stroke. There was no association between readmission and sex or race and no interaction between primary care and sex nor between primary care and race. Conclusion: Established primary care is protective from stroke readmission. In high risk patients (older age with ischemic stroke and prolonged length of stay), efforts should be made to arrange for primary care sooner than later.