Abstract W P274: Characterizing The “Universe” Of Transitional Care Programs For Stroke Survivors In The United States

Abstract

This study’s purpose is to characterize the range of TC programs for stroke survivors in a national sample of healthcare facilities in the U.S., as an initial step toward ultimately associating those characteristics with TC program outcomes. Hospitals in the following networks were invited to complete an electronic survey: The National Institute of Neurological Disorders and Stroke’s Neurological Emergencies Treatment Trials network and StrokeNet, the American Heart Association’s Get With The Guidelines hospitals, and the Michigan Health & Hospital Association. The survey inquired whether the facilities have stroke TC programs, program description, number of patients seen annually, facility type, and healthcare context. Out of 82 respondents, 65 hospitals reported a TC program, and 17 did not have such programs. Respondents include facilities from all five U.S. geographic regions. The 42 facilities that reported the annual number of patients served, served between 48.0-1974.0 patients (median 426.0, inter-quantile range 245.0-840.0). Of the facilities that reported hospital type, 23 (57.5%) are academic, 7 (17.5%) are academic affiliates, and 10 (25%) are community. Of the 25 facilities that reported the healthcare setting in which the TC program is delivered, 12 (48%) are delivered in a fee-for-service, 6 (24%) in integrated delivery system, 3 (12%) in traditional primary care, and 1 (4%) in a patient-centered medical home. TC program components reported (in descending order of frequency) include: Support services, call-backs, transitional planning, inpatient physical rehabilitation, care coordination, neurology follow up, telemedicine, home visits, anytime access. Of the 61 facilities that provided information regarding the TC program components 33 (51%) have one, 15 (23%) have two, 8 (12%) have three, and 5 (8%) have four components. This survey found substantial heterogeneity in TC programs. A standardized definition of TC program components is not available, hence the necessary first step in studying comparative effectiveness of TC programs is building a taxonomy of TC program components. This will enable analysis of the most effective TC programs, and ultimately guide improving the TC experience and outcomes for stroke survivors.