Continuity of care and 30-day readmission for patients evaluated in the emergency room after cerebral aneurysm treatment

被引：8

作者：

Bekelis, Kimon ^{[1
,2
,3
]}

Missios, Symeon ^{[4
]}

MacKenzie, Todd A. ^{[2
,3
,5
,6
]}

机构：

[1] Dartmouth Hitchcock Med Ctr, Sect Neurosurg, Lebanon, NH 03766 USA

[2] Geisel Sch Med Dartmouth, Hanover, NH USA

[3] Dartmouth Inst Hlth Policy & Clin Practice, Lebanon, NH USA

[4] Louisiana State Univ, Dept Neurosurg, Hlth Sci Ctr, Shreveport, LA 71105 USA

[5] Dartmouth Hitchcock Med Ctr, Dept Med, Lebanon, NH 03766 USA

[6] Dartmouth Hitchcock Med Ctr, Dept Community & Family Med, Lebanon, NH 03766 USA

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2016年 / 8卷 / 11期

关键词：

Aneurysm;

D O I：

10.1136/neurintsurg-2015-012162

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background The association between continuity of care and the rate of 30-day readmissions after surgical procedures continues to be debated. Objective To investigate the association of 30-day readmissions with evaluation in the hospital where the original procedure was performed for patients presenting to the emergency department (ED) after cerebral aneurysm treatment. Methods We performed a cohort study of patients with cerebral aneurysms, who were evaluated in the ED within 30 days after discharge following surgical clipping or endovascular coiling between 2009 and 2013, and were registered in the Statewide Planning and Research Cooperative System database. A propensity score adjusted model was used to control for confounding, whereas mixed effects accounted for clustering at the hospital level. Results Of the 452 patients presenting to the ED, 218 (48.2%) were evaluated in a different hospital from that in which the original procedure was performed (7.7% readmitted), and 234 (51.8%) were evaluated at the original hospital (18.4% readmitted). In a multivariable analysis, we showed that evaluation in the ED of the original hospital was associated with decreased rate of 30 day readmission (OR=0.41; 95% CI 0.22 to 0.78). We found similar associations in a mixed-effects logistic regression model (OR=0.46; 95% CI 0.35 to 0.84) and a propensity score adjusted model (OR=0.41; 95% CI 0.22 to 0.77). This corresponds to 10 patients needing to be evaluated in the hospital at which the original procedure was performed to prevent one readmission. Conclusions Using a comprehensive all-payer cohort of patients in New York State, who were evaluated in the ED after cerebral aneurysm treatment, we identified an association between assessment in the hospital at which the original procedure was performed and a lower rate of 30-day readmissions. This underlines the potential importance of continuity of care for surgical patients to prevent readmission.

引用

页码：1203 / 1206

页数：4

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