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Research

Readmission following hypoxic ischemic brain injury: a population-based cohort study

Vincy Chan, David Stock, Binu Jacob, Nora Cullen and Angela Colantonio
November 27, 2018 6 (4) E568-E574; DOI: https://doi.org/10.9778/cmajo.20180080
Vincy Chan
Toronto Rehabilitation Institute (Chan, Stock, Jacob, Cullen, Colantonio), University Health Network, Toronto, Ont.; Department of Clinical Health and Epidemiology (Stock), Dalhousie University, Halifax, NS; West Park Healthcare Centre (Cullen); Rehabilitation Sciences Institute (Cullen, Colantonio), University of Toronto; Institute for Clinical Evaluative Sciences (Colantonio), Toronto, Ont.
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David Stock
Toronto Rehabilitation Institute (Chan, Stock, Jacob, Cullen, Colantonio), University Health Network, Toronto, Ont.; Department of Clinical Health and Epidemiology (Stock), Dalhousie University, Halifax, NS; West Park Healthcare Centre (Cullen); Rehabilitation Sciences Institute (Cullen, Colantonio), University of Toronto; Institute for Clinical Evaluative Sciences (Colantonio), Toronto, Ont.
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Binu Jacob
Toronto Rehabilitation Institute (Chan, Stock, Jacob, Cullen, Colantonio), University Health Network, Toronto, Ont.; Department of Clinical Health and Epidemiology (Stock), Dalhousie University, Halifax, NS; West Park Healthcare Centre (Cullen); Rehabilitation Sciences Institute (Cullen, Colantonio), University of Toronto; Institute for Clinical Evaluative Sciences (Colantonio), Toronto, Ont.
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Nora Cullen
Toronto Rehabilitation Institute (Chan, Stock, Jacob, Cullen, Colantonio), University Health Network, Toronto, Ont.; Department of Clinical Health and Epidemiology (Stock), Dalhousie University, Halifax, NS; West Park Healthcare Centre (Cullen); Rehabilitation Sciences Institute (Cullen, Colantonio), University of Toronto; Institute for Clinical Evaluative Sciences (Colantonio), Toronto, Ont.
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Angela Colantonio
Toronto Rehabilitation Institute (Chan, Stock, Jacob, Cullen, Colantonio), University Health Network, Toronto, Ont.; Department of Clinical Health and Epidemiology (Stock), Dalhousie University, Halifax, NS; West Park Healthcare Centre (Cullen); Rehabilitation Sciences Institute (Cullen, Colantonio), University of Toronto; Institute for Clinical Evaluative Sciences (Colantonio), Toronto, Ont.
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Abstract

Background: Readmission to acute care is common and is associated with indicators of suboptimal care and health system inefficiencies. The objective of this study was to identify independent determinants of readmission following survival of hypoxic ischemic brain injury.

Methods: We conducted a population-based retrospective cohort study using Ontario’s administrative health data. Survivors of hypoxic ischemic brain injury aged 20 years or more discharged from acute care between fiscal years 2002/03 and 2010/11 were included. Multivariable negative binomial regression was used to identify independent determinants of both number of readmissions and cumulative duration of hospital stay(s) within 1 year after the index discharge.

Results: Of the 593 patients with hypoxic ischemic brain injury, 233 (39.3%) were readmitted within 1 year of the index acute care discharge. The number of readmissions was associated with age (35–49 yr v. 65–79 yr: rate ratio [RR] 0.57, 95% confidence interval [CI] 0.38–0.85; ≥ 80 yr v. 65–79 yr: RR 0.58, 95% CI 0.34–0.97) and higher comorbidity score (Johns Hopkins Aggregated Diagnosis Groups score > 30 v. < 10: RR 1.60, 95% CI 1.11–2.31). Cumulative readmission stay was associated with increased index acute care length of stay (31–90 d v. ≥ 90 d: RR 4.17, 95% CI 1.38–12.64), prior use of health care services (minimal v. very high: RR 0.15, 95% CI 0.05–0.49) and discharge disposition (home v. continuing/long-term care: RR 0.44, 95% CI 0.21–0.91).

Interpretation: The findings indicate a high readmission rate in the first year after the index acute care admission for survivors of hypoxic ischemic brain injury, reflecting care gaps and system inefficiencies. This suggests that bolstered discharge and home care planning and support are needed to address the specific needs of those with hypoxic ischemic brain injury.

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CMAJ Open: 6 (4)
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Readmission following hypoxic ischemic brain injury: a population-based cohort study
Vincy Chan, David Stock, Binu Jacob, Nora Cullen, Angela Colantonio
Oct 2018, 6 (4) E568-E574; DOI: 10.9778/cmajo.20180080

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Readmission following hypoxic ischemic brain injury: a population-based cohort study
Vincy Chan, David Stock, Binu Jacob, Nora Cullen, Angela Colantonio
Oct 2018, 6 (4) E568-E574; DOI: 10.9778/cmajo.20180080
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