Reliability of self reported rehospitalization

Hospital rehospitalization is considered a clinical marker for quality of care. Self-reported information on rehospitalization after stroke is important in follow-up up studies with advent of Hospital Rehospitalization Reduction Program under the Affordable Care Act. In person functional assessment and follow-up on rehospitalization is expensive and requires a home visit. The aim of this study was to find the agreement between self-reported rehospitalization and actual hospital rehospitalization in stroke population after discharge from inpatient rehabilitation. Patients aged ≥65 years on Medicare fee-for-service plan, history of prior admission to acute care facilities before inpatient rehabilitation were included in the study. Inpatient Rehabilitation Facilities Patient Assessment Instrument data was linked to their MEDPAR files and with Medtel follow-up data to determine the agreement between self-reported rehospitalizations and actual rehospitalization. Follow-up information after 90 days of discharge from inpatient rehabilitation was collected by trained clinician on telephone. The total sample was 4607. Out of which 75% were reported true rehospitalization within 90 days of discharge and 25% were not reported rehospitalization. Again within rehospitalization cohort 96% were showing agreement between self-reported and actual rehospitalizations, while in non-hospitalized cohort only 55% were showing agreement. The overall Kappa for self reported rehospitalization and actual rehospitalization was 0.58 with 95% CI (0.54 - 0.60). Result shows well enough agreement between self-reported rehospitalization and actual rehospitalization despite of under-reporting by patients on telephone. Tracking transition of care and rehospitalization after 90 days of discharge to the community may provide crucial information to improve healthcare outcomes following stroke.