Can readmission after stroke be prevented? Results of a randomized clinical study: A postdischarge follow-up service for stroke survivors

Background and Purpose-About 50% of stroke survivors are discharged to thei r homes with lasting disability. Knowledge, however, of the importance of f ollow-up services that targets these patients is sparse. The purpose of the present study was to evaluate 2 models of follow-up intervention after dis charge. The study hypothesis was that intervention could reduce readmission rates and institutionalization and prevent functional decline. We report t he results regarding readmission. Methods-This randomized study included 155 stroke patients with persistent impairment and disability who, after the completion of inpatient rehabilita tion, were discharged to their homes. The patients were randomized to 1 of 2 follow-up interventions provided in addition to standard care or to stand ard aftercare. Fifty-four received follow-up home visits by a physician (IN T1-HVP), 53 were provided instructions by a physiotherapist in their home ( INT2-P1), and 48 received standard aftercare only (controls). Baseline char acteristics for the 3 groups were comparable. Six months after discharge, d ata were obtained on readmission and institutionalization. Results-The readmission rates within 6 months after discharge were signific antly lower in the intervention groups than in the control group (INT1-HVP 26%, INT2-PI 34%, controls 44%; P=0.028). Multivariate analysis of readmiss ion risk showed a significant favorable effect of intervention (INT1-HVP or INT2-PI) in interaction with length of hospital stay (P=0.0332), indicatin g that the effect of intervention was strongest for patients with a prolong ed inpatient rehabilitation. Conclusions-Readmission is common among disabled stroke survivors. Follow-u p intervention after discharge seems to be a way of preventing readmission, especially for patients with long inpatient rehabilitation.