Abstract 72: Early Outpatient Followup With Primary Care is Associated With Lower Readmission at 30 and 90 days in Patients With Ischemic Stroke

Abstract

Background: Readmissions after ischemic strokes are common and associated with high morbidity and cost. Whether early follow-up after stroke can reduce readmissions remains unclear. We examined the relationship between follow-up after stroke hospitalization with primary care or neurology and readmissions at 30 and 90 days. Methods: A retrospective cohort study was performed using PharMetrics claims database of US commercial insurers from 2009 to 2015. Inclusion: (1) inpatient admission with primary diagnosis of ischemic stroke, (2) discharge home, (3) age 18-89, (4) 1 year of enrollment prior to stroke and 3 months after discharge. Exclusion: (1) stroke transfers, (2) repeat admission for stroke. The primary outcome was all-cause 30-day and 90-day hospital readmission. Multivariable Cox models were used with primary care and neurology visits specified as time-dependent covariates, adjusting for patient demographics, comorbidities (calculated for one year prior to stroke) and stroke severity measures. Results: The cohort consisted of 16,965 patients (table). Readmissions at 30 days occurred in 6.56% of patients at a median (interquartile range) of 12 days (5-20). Readmissions at 90 days occurred in 13.2% of patients at a median of 31 days (12-58). By 30 days, 50.2% had a primary care visit and 17.1% had a neurology visit. Patients with a primary care visit within 30 days had a 23% lower rate of readmission than those who did not (hazard ratio [HR], 0.77; 95% confidence interval, 0.66-0.89). The association is less strong for primary care visits within 90 days and readmissions (HR 0.88; 0.80-0.98). Neurology follow-up did produce benefit but did not reach significance. Conclusion: Early outpatient follow-up with primary care is associated with a significant reduction in hospital readmission. Even though this was an insured population, almost half of all patients did not receive primary care follow-up at 30 days, which represents an opportunity for intervention.