Journal article
A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke
Journal of stroke and cerebrovascular diseases, Vol.29(9), 105053
09/2020
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105053
PMID: 32807459
Abstract
•Readmissions and mortality are common among patients with acute ischemic stroke.•Readmission is an independent risk factor of mortality.•Continuity of care reduces readmission, mortality and hospital length of stay.
Continuity of care is a core element of high-quality patient care in a primary care setting and one of a national priority.
To assess and quantify the impact of continuity of care on 30-day readmissions, 30-day inpatient mortality, and hospital length of stay (LOS), among hospitalized patients with acute ischemic stroke disease.
Observational retrospective cohort (n = 356,134) using a 2.75% random sample (n=1,036,753) from the State of Florida Agency for Health Care Administration (AHCA) database from 2006 to 2016.
We assessed continuity of care using an integrated continuity of care CoC score, calculated by merging three standard indices of continuity of care – Bice–Boxerman Continuity of Care Index (COCI), Herfindahl Index (HI), and Usual Provider of Care (UPC) Index via a Principal Component Analysis (PCA). We measured 30-day hospital readmissions, 30-day inpatient mortality, and LOS.
Our analysis revealed that hospital LOS was significantly affected by CoC. The statistically significant average treatment effect (ATEs), expressed in risk difference (RD), ranged between 0.27 [95%CI: (0.07, 0.48)] and 1.0 day [95%CI: (0.57, 1.43)]. A similar trend was observed for 30-day readmission (ATEs ranging from 0.0067 [95%CI: (0.0002, 0.0132) to 0.0071 [95%CI: (0.0005, 0.0136)]), and inpatient mortality (ATEs ranging from 0.0006 [95% confidence interval (CI): (0.0001, 0.0012)] to 0.0007 [95%CI: (0.0001, 0.0012)]).
Our findings suggest a strong association between continuity of care and clinical outcomes. Continuity of care leads to a reduction in mortality, rehospitalization, and hospital length of stay.
Details
- Title: Subtitle
- A quantitative analysis of the effect of continuity of care on 30-day readmission and in-hospital mortality among patients with acute ischemic stroke
- Creators
- Arinze Nkemdirim Okere - College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1415 Martin Luther King Jr. BLVD, Tallahassee, FL 32307, USAVassiki Sanogo - University of FloridaRajesh Balkrishnan - University of VirginiaVakaramoko Diaby - University of Florida
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.29(9), 105053
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jstrokecerebrovasdis.2020.105053
- PMID
- 32807459
- ISSN
- 1052-3057
- eISSN
- 1532-8511
- Language
- English
- Date published
- 09/2020
- Academic Unit
- Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984845054102771
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