Abstract P279: Using Systems Redesign to Develop, Implement, and Evaluate the Effectiveness of a Care Transitions and Hypertension Management Program for Veterans With Ischemic Stroke

Abstract

Introduction: Patients are routinely discharged after an ischemic stroke with uncontrolled hypertension; blood pressure (BP) at discharge predicts BP 6-months post-discharge. Hypothesis: Systems Redesign approaches can develop and implement effective interventions using existing infrastructure more efficiently to improve care transitions and hypertension management for Veterans 6-months post-stroke. Methods: Two external facilitators with expertise in clinical stroke care and Systems Redesign conducted a rapid process improvement workshop with local healthcare personnel and hospital leadership within a large VA medical center providing suboptimal post-stroke BP control. The team process mapped out the current state of BP control post-stroke and conceptualized a future state with enhanced care coordination between inpatient and outpatient providers and increased engagement of underutilized talent within clinical pharmacy and telehealth. The CAre Transitions and Hypertension (CATcH) management program was created and implemented. Chart review was conducted to collect data related to BP and healthcare utilization. Categorical variables were examined by calculating frequency distributions and using chi-square or fisher’s exact tests. Results: A total of 76 Veterans were the recipient of the CATcH program. Compared to Veterans admitted in the 6-months prior to program implementation, utilization of clinical pharmacy (68.4% versus 33.3%; P =0.0002) and telehealth services (48.7% versus 4.2%; P <0.0001). CATcH patients were also more likely to return home/home with services than historical controls (86.6% versus 60.4%; P =0.003). Mean (SD) systolic BP reduction from discharge to 6-month follow-up these CATcH patients was 8.9 (5.3) mmHg. Rates of readmission to the hospital and presenting to the emergency room within the 6-months post-discharge period were not significantly different between groups. Conclusions: Systems Redesign could be used retool existing workflow and enhance care coordination and collaboration. Improving processes related to care transitions and post-stroke hypertension management increased the likelihood of returning to home/home with services and BP control for stroke survivors.