Abstract
Background: Stroke Prevention Clinics were established in 2009 with the expectation that all stroke patients would follow up at 30 days after discharge to review their plan of care. Purpose: We sought to determine the barriers to meeting our goals. Methods: All UHCMC hospital discharges for TIA/ ischemic stroke from 2/1/10-5/31/10 (wave 1) and 12/1/12-3/31/13 (wave 2) were reviewed and data collected on post-discharge ambulatory visits, patient demographics, insurance and provider status, discharge disposition, appointments scheduled prior to discharge, and patient responses to personal telephone reminders prior to their follow up visit. Results: In Wave 1, significant (p< .05) vulnerability factors for patients “No Show” to follow up included discharge to a facility but systems issues played a greater role for those who were older, male, and African-American. These factors persisted in Wave 2 and also included lack of a prior PCP (40% vs 12%). Systems issues included discharge without a confirmed follow up appointment and inaccurate contact information to confirm or reschedule appointments. Conclusions: Despite Stroke Education sessions emphasizing the importance of follow up after discharge, 38-46% of patients had no documented stroke preventive care. Systems improvements implemented after Wave 1 were effective in reducing this gap from 25% to 12% in Wave 2 and included customizing the EMR Discharge Profile for Stroke with specific written messages, establishing a Care Coordinator to teach back with patients and families, and streamlining scheduling processes. However, patient factors are increasing and the expanded vulnerable population has increased disability and greater unmet needs. Focused interviews are being conducted to better understand these barriers to care.
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