Abstract 207: The Stroke Prevention Clinic, Extending Care Past The Stroke Center

Abstract

Background: While the incidence and mortality from stroke in the United States has declined in the past 20 years, there are still more than 795,000 strokes per year, of which 185,000 are recurrent events. There remains great disparity between racial groups -the incidence and mortality among African Americans, is two to four times higher than Non-Hispanic Whites. Despite great advances in drug therapies, the impact on stroke prevention has not been fully realized. There is a need for improved delivery of effective treatments. Several randomized clinical trials have demonstrated the effectiveness of a comprehensive; clinic based, navigator-assisted approach to disease management, although in the context of specific clinical situations. Examples are, SAMMPRIS, and Look AHEAD. We propose that learning from the development of the “stroke center” for acute stroke care, we may apply a similar model to stroke prevention. We have created a Stroke Prevention Clinic (SPC), organized like an outpatient “stroke center”, offering evaluation, treatment, and long-term follow up of patients for risk factor control and lifestyle interventions for secondary prevention. Our Stroke Prevention Nurse is an integral part of this model. In this abstract we report the impact of this program on follow up rates. Methods: In 2011 we launched our SPC. The specific elements of this program included: A Stroke Prevention Nurse: a. Meets the patient in the hospital. b. Facilitates scheduling of appointments, including in the SPC, which is given to the patient upon discharge. c. Calls the patient within 7 days to do medication reconciliation and answer questions. Also, at 90 days for a modified Rankin score and whenever it is necessary to follow up on blood pressure readings. d. Administers screening tools upon follow up, consents for research studies. e. Educates the patient on stroke prevention. Dedicated day for clinic. All providers in the same area. Use of Advance Practice Nurse and stroke fellows, as well as vascular neurology attending. Database. We assessed the proportion of completed appointments within 90 days after discharge from the hospital and compared it with the year prior to implementation. Results: A sample from July 2010 to February 2011 revealed completed follow up by 90 days of 28.3% (70/247), for the period July 2011 to February 2012 the proportion was 35.6% (89/250). During calendar year 2014, 54.3% (233/429) completed their appointments within 90 days. Conclusion: Implementation of the Stroke Prevention Clinic increased follow up completion within 90 days of discharge.