Patient Factors Associated With Attendance at a Comprehensive Postacute Stroke Visit: Insight From the Vanguard Site

Abstract

Objective To understand the patient-influenced activities and characteristics associated with return to a single postacute care transitional care clinic visit in a cohort of patients cared for at the test health system site of the larger Comprehensive Post-Acute Stroke Services (COMPASS) cluster randomized trial. Design Retrospective cohort. Setting A large health system. Participants Patients discharged directly home between June 2016 and June 2018 after sustaining a stroke who did not receive formal inpatient rehabilitation services while being cared for in a single comprehensive stroke center, defined as a center that meet standards to rapidly diagnose and treat the most complex stroke cases. Interventions Study participants had the opportunity to participate in a (1) 2-day call, (2) comprehensive care transitions clinic visit, and (3) individualized care plan. Main Outcome Measures Patient participation in a single postacute care comprehensive care transitions visit, ideally completed within 7-14 calendar days post discharge vs not attending this visit. Care transition visits are where the responsibility for preventive care, other services, and posthospital follow-up are transitioned to outpatient providers. Results Among 1300 eligible patients (mean age 64.8 years; 45% female; 25.4% nonwhite; 9.7% uninsured), 95.7% had follow-up clinic visits scheduled before discharge, 22.6% received home health referrals before discharge, 60.2% completed the 2-day call, and 63.2% attended the COMPASS visit. Among attendees, 33.2% attended by day 14, 71.3% attended within 30 days, and 28.7% attended after day 30. The median driving distance to the COMPASS visit was 45.9 miles or 73.9 km. Odds of visit attendance were higher if COMPASS 2-day follow up calls were completed, if follow-up clinic appointments were scheduled before discharge, if the patient had a primary care provider, and if the patients experienced a stroke vs a transient ischemic attack. Additionally, when we used the number of referrals at hospital discharge for different types of outpatient therapy as a surrogate marker of poststroke impairment, patients having no therapy referrals (milder to no impairments) had lower odds of attending the COMPASS visit than those with 1 therapy referral. Likewise, those with more than 1 referral were also less likely to attend the COMPASS visit. Conclusions This analysis highlights that scheduling visits at discharge and completing timely telephone follow-up shortly after discharge may lead to greater adherence to in-person clinic follow-up after stroke.

Telemedicine impact on post-stroke outpatient follow-up in an academic healthcare network during the COVID-19 pandemic

“…The clinical coordinator contacted these patients via phone to schedule an appointment by 3 months. The benefit of post-discharge telephone communication and patient reminders has previously been established, 1 and our findings support this approach as a potential mechanism to benefit other patient groups with follow-up reminders after discharge.…”

“…Outpatient follow-up after acute stroke plays a significant role in optimizing patient care, secondary stroke prevention and reducing morbidity and mortality. 1 As the risk of recurrent stroke is highest within the first six months following stroke, prompt outpatient follow-up is essential for secondary prevention of future complications and minimizing the risk of hospital readmission. 2 , 3 , 4 Outpatient in-person follow-up represents one strategy.…”

Telehealth Trials to Address Health Equity in Stroke Survivors

“…Other lessons learned from Comprehensive Post-Acute Stroke Services are that there were a few patient-level barriers that were critical for implementation of the new model of care, but the most important was that transportation and distance from the clinic prevented patients from keeping the appointment to receive the care plan. 53 In addition, there was no impact of the Comprehensive Post-Acute Stroke Services model of care on readmissions at 90 days or 1 year, and this clearly pointed to the fact that stroke care needs to continue beyond the transitional period of the first 30 days post-discharge. 77 The TEAMS-BP intervention spans the first 6 months after discharge, and also includes health coaching to reinforce the care plan with the patient and caregiver over time.…”

“…With limited access to stroke subspecialists in many regions, going to in-person appointments may involve traveling long distances. 53 Remote care, especially in home, is an appealing solution to these barriers to care. Additionally, stroke survivors who transition to skilled nursing facilities or inpatient rehabilitation centers could also benefit from remote neurology follow-up visits.…”