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Stroke Research and Treatment
Volume 2017, Article ID 7062146, 12 pages
Research Article

Sequence Analysis of Long-Term Readmissions among High-Impact Users of Cerebrovascular Patients

1Faculty of Medicine, Dr Foster Unit, Imperial College London, 3 Dorset Rise, London EC4Y 8EN, UK
2Faculty of Medicine, Institute of Global Health, Imperial College London, St Mary’s Hospital, Praed Street, London W2 1NY, UK

Correspondence should be addressed to Ahsan Rao;

Received 19 January 2017; Revised 28 March 2017; Accepted 23 April 2017; Published 16 May 2017

Academic Editor: David Vaudry

Copyright © 2017 Ahsan Rao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Understanding the chronological order of the causes of readmissions may help us assess any repeated chain of events among high-impact users, those with high readmission rate. We aim to perform sequence analysis of administrative data to identify distinct sequences of emergency readmissions among the high-impact users. Methods. A retrospective cohort of all cerebrovascular patients identified through national administrative data and followed for 4 years. Results. Common discriminating subsequences in chronic high-impact users () of ischaemic stroke () were “urological conditions-chest infection,” “chest infection-urological conditions,” “injury-urological conditions,” “chest infection-ambulatory condition,” and “ambulatory condition-chest infection” (). Among TIA patients (), common discriminating () subsequences among chronic high-impact users were “injury-urological conditions,” “urological conditions-chest infection,” “urological conditions-injury,” “ambulatory condition-urological conditions,” and “ambulatory condition-chest infection.” Among the chronic high-impact group of intracranial haemorrhage () common discriminating subsequences () were “dementia-injury,” “chest infection-dementia,” “dementia-dementia-injury,” “dementia-urine infection,” and “injury-urine infection.” Conclusion. Although common causes of readmission are the same in different subgroups, the high-impact users had a higher proportion of patients with distinct common sequences of multiple readmissions as identified by the sequence analysis. Most of these causes are potentially preventable and can be avoided in the community.