Abstract 270: Primary and Specialty Care Follow-up Appointments after Stroke: Rates, Variability, and Opportunities for Improvement
Background: Follow-up care after an acute stroke can facilitate patient recovery and limit recurrence. In other disease states, scheduling a follow-up appointment with primary and specialty care prior to hospital discharge can facilitate smooth care transitions. However there are limited data on the variability in care continuity after acute stroke.
Methods: We examined overall and hospital specific rates of follow-up appointments with primary care and specialty care scheduled prior to hospital discharge among the 44 Ohio Coverdell Stroke Program hospitals. Patients of any stroke type, without documented comfort measures, and discharged home, alive and not to hospice care were eligible for a follow-up appointment with primary care. To be eligible for the specialty care appointment, patients of any stroke type needed an order for a follow-up appointment with a neurologist or neurosurgeon, be without documented comfort measures, and discharged home, to rehabilitation or a skilled nursing facility. Multivariable logistic regression was used to examine patient and hospital factors associated with each follow-up appointment measure. Facilitators and barriers to scheduling appointments prior to discharge were reported by stroke team members at a meeting of participating hospitals.
Results: Of the 4,162 patients eligible for the specialty care measure over 6 months, 24.8% had a neurologist or neurosurgeon appointment scheduled before hospital discharge. Hospital-level specialty appointment arrangement ranged from 0-83%. Among 3,141 patients eligible for a primary care appointment, 14% had one scheduled prior to discharge; hospital specific variability ranged from 0-50%. In the multivariable model, age, gender, stroke type, insurance type, and hospital stroke volume were not associated with either primary or specialty care appointments. Facilitators of follow-up care reported by some participating hospitals were paradoxicallly reported as barriers by others. These included availability of dedicated personnel to plan with the patient and family and schedule with post-hospital providers, functionality of electronic medical records, provider perspectives on the importance of follow-up, schedule availability of post-hospital providers, geographic accessibility for patients, integration with other discharge planning processes, and inclusion of the scheduled appointments on discharge summaries for patients.
Conclusions: A high proportion of patients with acute stroke failed to have a primary care or specialty care follow-up appointment scheduled prior to discharge and this varied widely across participating hospitals. A collaborative approach for data-driven change and exchange of local best practices and facilitators could lead to significant improvement.
Author Disclosures: J. Prvu Bettger: C. Other Research Support; Significant; Ohio Department of Health. I. Katzan: C. Other Research Support; Modest; Ohio Department of Health. S. Lender: A. Employment; Significant; U.S. Centers for Disease Control and Prevention (1U58DP003965). A. Liskay: C. Other Research Support; Significant; Ohio Department of Health. A. Loechler: None. D. Bayt: A. Employment; Significant; U.S. Centers for Disease Control and Prevention (1U58DP003965). B. Pryor: None. E.D. Peterson: None. D. Nutter: A. Employment; Significant; U.S. Centers for Disease Control and Prevention (1U58DP003965).
- © 2014 by American Heart Association, Inc.