Abstract WP426: Implementation of a Stroke Nurse Navigator in Addition to Stroke Care Path Improves Readmission Rates

Abstract

Background and Purpose: Inpatient care during the acute and post-acute phases is complex and requires an interdisciplinary approach. High quality metrics have become an integral part of achieving value-based care. The addition of Bundled Payments for Care Improvement Advanced will continue to drive Stroke Centers to deliver high quality, low cost care during the acute phase and the 90 days post discharge. A pilot program was implemented to create a stroke care pathway and incorporate stroke nurse navigators in the interdisciplinary team to improve patient outcomes and quality metrics. Acute stroke patients are followed by nurse navigators throughout the hospitalization and for 90 days post discharge. Methods: A retrospective analysis of a prospectively collected database was carried out. This database incorporated data from the electronic medical records and crossed referenced with insurance claims data. We included patients admitted to our stroke center from January 2017 until December 2018. The stroke care path was initiated in May of 2017. We collected quality metrics including length of stay, readmission rates, inpatient therapy days as well as 90 day total episode costs. Patient demographics and clinical data were also collected. Results: We identified 1407 patient that met inclusion criteria. 48.3% of these patients were pre-care path. All cause re-admissions significantly decreased from 10.1% to 5.3% (OR 0.49; 95%CI 0.33 - 0.74, p <0.001) after the implementation of the care pathway. Length of stay reduced from 6.3 to 5.9 days post carepath. Inpatient therapy days have increased from 3.3 days to 4.7 days per hospitalization. Total costs per episode decreased from $41,576 to $40,580. Conclusions: The implementation of nurse navigators in addition to standardized care pathway led to significant reduction in readmission rates, increased inpatient therapy utilization days, increased patient and decreased overall episode costs.