A Pilot Population-Based Outcomes Study Using a Health Information Exchange (HIE): Demographic Comparison of Groups (P07.047)

Abstract

Objective: We compare demographics and outcomes between two distinct cohorts recruited from the same stroke population: a cohort tracked using in person (IP) interview and a cohort tracked using HIE and a “virtual” telephone interview. Background Post-stroke outcomes are traditionally determined by longitudinal follow-up with IP interview, which is expensive, time consuming and prone to bias. Alternative follow up methods have yet to be explored, especially for considering a population-based outcomes study. Design/Methods: We ascertained all ischemic stroke cases from within our geographic study population during 2010 using HIE messages from all ER/hospital admissions to any of the 16 hospitals in the region. Potential stroke cases were flagged using a computerized algorithm identifying key words. Cases were approached for inclusion in an IP interview cohort using hot pursuit methodology. Those not approached were considered for the HIE cohort. Demographics and key outcomes were compared between cohorts. Results: During 2010, the HIE received 17,671,258 messages about 1,967,415 unique patients seeking care at the regions hospitals. There were 689 ischemic stroke subjects approached during hospitalization; 516 agreed to participate and 408 completed a 3-month IP interview. The HIE cohort consisted of 581 subjects, 532 still living, of whom 116 refused and 215 completed telephone interviews. Race, gender, payor, baseline modified Rankin score (mRS), discharge/30 day mRS, and 3 month mRS were similar between cohorts. Compared to the HIE cohort, the IP cohort was younger (67 vs. 70 years), required less proxy interview (21% vs. 34%), and were less likely to be cognitively impaired (25% vs. 39%), all p Conclusions: The HIE cohort included participants not represented in the IP cohort. Our next steps include investigating how such biases impact modeling of post-stroke outcomes and looking for differences among refusals in each method. Supported by: NINDS R-01 NS30678, “Hemorrhagic and Ischemic Strokes Among Blacks and Whites”. Disclosure: Dr. Kissela has received personal compensation for activities with Allergan and Medicolegal Review. Dr. Kissela has received research support from NexStim. Dr. Alwell has nothing to disclose. Dr. Khoury has nothing to disclose. Dr. Moomaw has nothing to disclose. Dr. Embi has nothing to disclose. Dr. Rademacher has nothing to disclose. Dr. Lindsell has nothing to disclose. Dr. Woo has nothing to disclose. Dr. Flaherty has received personal compensation for activities with Boehringer Ingelheim Pharmaceuticals, Inc. Dr. Flaherty has received research support from NINDS and Novo Nordisk. Dr. Khatri has received personal compensation for activities with law offices as an expert witness. Dr. Khatri has received research support from Genentech, Inc. and Penumbra, Inc. Dr. Adeoye has received personal compensation for activities with EKR Therapeutics for Speaker9s Bureau and consultant services. Dr. Ferioli has nothing to disclose. Dr. Kleindorfer has received personal compensation for activities with Genentech, Inc. and Boehringer Ingelheim Pharmaceuticals, Inc. as a speaker and participant on an advisory board.