Abstract 3784: Postdischarge Follow-up Appointments After Stroke In Ohio - Current Status And Room For Improvement

Background: There is an increasing realization of the importance of postdischarge follow-up (f/u) after hospitalization for stroke. As a quality improvement initiative of the Ohio Coverdell Stroke Registry, several questions related to post-discharge f/u appointments were added to the Ohio Coverdell Get with the Guideline - Stroke data collection form. Methods: Four questions related to documentation of f/u appointments made prior to discharge was added to the GWTG-Stroke form in 2009 including: f/u with a neurologist, f/u with the patient’s primary care physician (PCP), whether a new PCP was assigned in patients without one and lastly whether f/u was made with a newly assigned PCP. Analysis of data was performed after excluding patients who died or were made comfort care during the stroke admission. Generalized estimating equation (GEE) was used to adjust for correlations within hospitals. Results: There were 15,712 patients between 1/2009 to 7/1/2011, with mean age 68.9 (SD 14.6) The majority (79.8%) were white and 52.5% were female. At least one f/u question was completed in 49% patients (n=7757), with completion rates increasing over time. F/u appointments with PCP were documented prior to discharge in 12.4% (676/5455) cases. A new PCP was assigned in 26.6% (173/651) pts without one and f/u appointments were documented in 14.0% (105/751) with these new assignments. Appointments with a neurologist were made 26.3% (1042/3967). Rates of documented f/u with both PCP and neurologists improved over the study period. Using adjusted means, rates of neurology f/u were higher in males than females (16.1.0% vs 15.0%, p<0001) blacks vs whites (24.90 vs 12.8%, p<0.0001) and in pts discharged to rehab vs home (25.8% vs 13.5% p<.0001). The pattern was similar for PCP f/u. There was wide variability in rates of documented f/u appointments across hospitals (range 0 - 100%). Implications: Establishing postdischarge f/u with PCPs and neurologists represents a potentially measurable and clinically important avenue to optimize outcomes after stroke. Data from Ohio Coverdell suggests considerable room for improvement in making with f/u appointments with both PCPs and neurologists. Further evaluation of the impact of postdischarge f/u and its potential use as a quality measure is warranted.