Background: Functional outcomes after stroke are important to patients but not found in administrative data. Using a hospital quality improvement program to assess outcomes 3 months after discharge, we examined the relationship between outcome measured with the Stroke Impact Scale-16 (SIS-16) and sex, comorbidities, depression, and risk factors.
Methods: We enrolled patients with ischemic/hemorrhagic stroke or TIA in an ongoing hospital-supported quality improvement program focused on transitional care and outcomes (TRAnsition Coaching for Stroke or TRACS). SIS-16 assesses self-reported mobility, arm strength, and basic/instrumental ADLs. Transformed scores range from 0 (worst) to 100 (best). Questionnaires were mailed 3 months post-discharge or collected by phone if no mailed response. Bivariate associations between baseline covariates and SIS-16 were analyzed, followed by stepwise linear regression modeling to assess independent predictors of SIS-16, adjusted for NIHSS.
Results: We captured 90-day outcomes on 129 patients from 9/2011 to 4/2015; mean age was 66.0 y -(+12.3), 45.7% women, 73% white, and mean NIHSS 4.0 + 5.2. Twenty-eight percent had diabetes, 82% hypertension, 15.6% CAD, 35% prior stroke/TIA, 7% pre-stroke depression. Therapy types included 37% with none, 14.7% inpatient, 24% home health, and 23.2% outpatient. Overall SIS-16 was 81.1 (+21.01). Women, non-white race, and NIHSS were associated with lower SIS-16 (table). In a stepwise linear regression model adjusted for NIHSS (p<0.0001), female sex (p=0.007), and non-white race (p=0.002) were associated with poorer functional status, with a trend in those with prior stroke/TIA (p=0.095). This model explained 31% of the variance in SIS-16.
Conclusion: Controlling for stroke severity, women, minorities, and those with prior stroke had lower functional status 3 months after stroke. Future quality improvement projects could target improving outcomes in these groups specifically.