Abstract T P308: Re-assessment of Lipid Profiles in Stroke Patients Post-hospital Discharge - Room for Improvement

Abstract

Introduction: According to guidelines patients receiving a lipid-lowering agent at discharge for stroke should receive follow-up lipid profile. Our measure takes the currently collected STK-6, one step further and tries to identify whether these patients receive follow-up lipid testing by comparing non-abstracted electronic health record data to abstracted data. Methods: Data was extracted from the Cleveland Clinic EMR (Epic Systems, Inc.) utilized by the Cleveland Clinic Health System (10 hospitals and 16 family health centers). The cohort was based on patients with an admission for stroke from 2008 to 2012 utilizing STK-6 criteria. We examined this cohort for whether they received a lipid panel within the 12 months after the discharge date and limited patients to those that received follow up encounters at our healthcare system. Demographic factors including age, gender, race, ethnicity, distance to hospital, primary diagnosis for hospitalization and presence of comorbid conditions were also extracted. This data was compared to our abstracted publically reported STK-6 data which comes from claims data. Results: Of the 508 patients included in results for STK-6 reporting, only 391 (77%) were also identified through the EMR. Of these, 274 patients had follow up at least one year within the healthcare system. Only 97(35%) patients had lipid panel lab results indicated in the EMR within one year of discharge. Testing was not statistically different based on patient characteristics: patients < 70 yrs vs 70+ (37% vs 30%, p=0.27), whites vs non-whites (35% vs. 36%, p=0.93), males vs. females (39% vs 30%, p=0.12). There was no significant difference in distance to the hospital from patients primary residence either between those without and with follow up lipid testing (mean distance=39 miles vs.17 miles, p=0.22). Conclusions: Follow up lipid testing following stroke discharge is not consistently performed among patients treated at a large healthcare system. There are not any highly significant differences in testing based on patient demographic characteristics or distance to the hospital. Further understanding of the reasons for poor follow up testing is required as well as evaluating concordance of the data pulled from the EMR when compared to abstracted data.