Abstract T P264: Does a Change in Coverage Equal a Change in Care?

Abstract

Introduction: During academic year 2012-13 (FY 2013) coverage for neurology patients at Strong Memorial Hospital (SMH) changed. Non-vascular neurologists admitted patients, many of whom were not evaluated by vascular neurologists. Previously stroke patients were evaluated by/admitted to a vascular neurologist. Hypothesis: We sought to determine if this translated into differences in care, hypothesizing decreased utilization of vascular imaging (VI) and compliance with regulatory measures. Methods: Metric data were obtained from SMH Get with the Guidelines (GWTG) from July 1, 2011-March 31, 2014. Reports were reviewed for percent compliance. SAH patients and acute stroke metrics were excluded. VI data were obtained from the Stroke Treatment Alliance of Rochester registry and reviewed for percent testing completed. Stable was defined as less than 5% change. Results: Improving or stable metrics: VTE prophylaxis, patient education, antithrombotic, anticoagulant, statin at D/C, assessment for rehabilitation, dysphagia screening, smoking cessation, and LDL documented. Increased utilization of MRA (8.4% FY2012 to 16.9% FY2013) and decreased CTA (80.3% FY2012 to 63.5% FY2013) were seen. Several metrics and VI had transient variation seen in figure 1 (high dose statin data incomplete before Q22012). Conclusions: Core measures remained stable. This may be attributable to the role of Stroke Nurse Practitioner (NP) which remained constant. The NP is responsible for coordination of care, guideline adherence, and training residents in guideline driven order sets. Anecdotal reports from faculty identified the NP as a source of stroke expertise. There was clear change in utilization of VI and NIHSS. While high dose statin use is difficult to interpret due to incomplete data, there was a large increase following FY2013. This demonstrates measurable benefits of utilizing vascular neurologists and stroke trained NPs to achieve high level care at a large academic institution.