Abstract T P382: Urgent Primary Care Physician Follow up is Associated with Reduced Stroke Readmission after Acute Ischemic Stroke Hospitalization

Introduction: Readmission after acute ischemic stroke is common and costly, with an average rate of 14.8% within 30 days of discharge1. In 2010, as part of a hospital performance improvement strategy, ischemic stroke patients who were discharged to home had an urgent (within 7 days) appointment with Primary Care Physician (PCP) scheduled. We compared 30-day readmission rates for those who kept and did not keep their appointment. Methods: Data from an electronic medical record system was retrospectively evaluated. The cohort included all patients with hospital admission for ICD 9 diagnosis of ischemic stroke (433, 434, 435) during the years 2010 - 2013. Only those with a discharge disposition of home were included. Group 1 included patients discharged to home who kept follow up appointment. Group 2 included those who did not keep their scheduled appointment. Significant predictors of readmission such as age, heart failure, diabetes, LACE score were compared. Fisher’s Exact test was used for categorical variables. Results: A total of 349 ischemic stroke patients were discharged to home during the study period. Of these, 250 had appointments scheduled, and 167 (66.8%) kept these appointments (Group 1). The average age was 69.2 and 68.3 with average LACE of 9.7 and 9.5 for groups 1 and 2 respectively. There was no significant difference in rates of diabetes or heart failure between groups. There were 7 (3.6%) readmissions in group 1 and 19 of 83 (22.9%) in group 2. Five patients were readmitted prior to appointment time in group 2, so were not entered into final calculation; this left readmission rate of 14/83 (16%); p =0.004. Conclusion: Urgent follow up with PCP may prevent hospital readmission in those with mild strokes. Reverse causation, from missing appointment due to hospital readmission did not account for these results. Although NIHSS was not compared, our cohort consisted of those with mild symptoms, given home disposition. Further study is needed to determine which elements of the PCP follow up visit are most effective in reducing hospital readmission. Reference: 1. Lichtman, JH. Leifheit-Limson, EC. Predictors of Hospital Readmission after Stroke: A Systematic Review Stroke. 2010; 41(11): 2525-2533.