Do clinical nurse specialist led stroke follow-up clinics reduce post-stroke hospital readmissions and recurrent vascular events?

Abstract

Post-discharge stroke follow-up clinics intend to improve care and may reduce readmission. Pre-2013, there was no consistent post-stroke specialist follow up offered at Wellington Hospital. We tested whether the establishment of a clinical nurse specialist follow-up clinic reduced the 12-month readmission rate. This is a sequential comparison of stroke patients admitted 1 year prior and 1 year after clinic establishment in 2013. The primary outcome was 12-month hospital readmission rate; main secondary outcomes were guideline adherence and recurrent vascular events. Patients were identified from hospital discharge records and underwent chart review. We adjusted results for differences in baseline characteristics. We identified 603 eligible patients; 288 pre- and 315 post-nurse clinic implementations. There was no difference based on study cohort in the 1-year readmission rate (adjusted odds ratio (aOR) = 1.14; 95% CI, 0.7-1.89; P = 0.583), or recurrent composite vascular events at 1 year (aOR = 1.56; 95% CI, 0.89-2.9; P = 0.159). When looking at clinic attendance as the main variable of interest, a pre-specified sub-group analysis, there was a significant difference in implementation of best medical therapy (aOR 2.66 (1.19-5.94); P = 0.017), and a trend towards reduction of vascular events and/or death at 1 year post discharge (aOR 0.53 (0.28-1.02); P = 0.056). There was no reduction in the 1-year hospital readmission or vascular event recurrence rate for patients admitted with stroke following the establishment of a specialist nurse-led stroke follow-up clinic. Actual clinic attendance, however, did appear to confer some benefit. This study suggests that more consistent and potentially earlier timed follow up is probably desirable.