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Factors Related to Preventable Hospitalization among VHA Stroke Patients

Chuang HC, Jia H, Cowper Ripley DC, Vogel WB, Wu SS, Chen JG, Litt E, Reker DM. Factors Related to Preventable Hospitalization among VHA Stroke Patients. Poster session presented at: VA HSR&D National Meeting; 2008 Feb 15; Baltimore, MD.


Objectives: To examine preventable hospitalization use and to assess whether the odds of using a preventable hospitalization can be explained by observed differences in a VHA stroke patient's sociodemographic and clinical characteristics. Methods: The study cohort consisted of all VHA patients with acute stroke in 2001 and 2002 who survived initial 12 months post-stroke. High-specificity stroke ICD-9 codes were applied in VHA inpatient databases to determine the patients' eligibility in the study. Institute of Medicine's preventable hospitalization definition was modified by adding secondary ischemic stroke during the first 12 months post-stroke. A logistic regression model was fitted to estimate the impact of potential risk factors on the use of preventable hospitalization. Results: Among the study cohort (N = 7267), 9% had at least one time use of preventable hospitalization during the 12 months follow up. The number of hospitalizations totaled 824 with congestive heart failure (21%), urinary tract infection (20%), pneumonia (18%), ischemic stroke (11%), and chronic obstructive pulmonary disease (10%) being the most frequently occurred conditions. Our logistic regression results suggest that being 10 years older (adjusted odds ratio or AOR 10.2), frequent users of pre-stroke inpatient care (AOR 1.4), having high priority for VHA care (AOR 1.8), more comorbid conditions (AOR 1.2), 10 days longer in index hospitalization stay (AOR 10.1), discharged to nursing home (vs. to home) at index (AOR 1.3), or living closer to a VHA medical center (AOR 1.4) increase the odds of a preventable hospitalization use at 0.05 significance level. Implications: Several sociodemographic and clinical characteristics were found to be significantly associated with preventable hospitalization among VHA stroke patients. Because stroke patients are older with heavier burden of comorbid conditions, frequent users of pre-stroke inpatient service, and need long-term care post-stroke, VHA policy makers should address the complex and special health delivery needs of its enrollees with stroke in order to reduce the patients' preventable hospitalization use. Impacts: Access to timely and effective ambulatory care by the stroke patients could reduce the risk of preventable hospitalization and VHA's healthcare cost, and may enhance the patients' functional recovery and quality of life post-stroke.

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