Background: Stroke is a leading cause of hospital admissions among the elderly, and reducing readmission rates has become a primary goal of healthcare reform. Hospitals are now being held financially responsible for 30 day readmission rates exceeding their expected rate . Our aim was to determine if patients seen in the comprehensive stroke discharge clinic had reduced 30 day readmissions compared to standard hospital follow up after ischemic stroke.
Methods: Patients with a discharge diagnosis of ischemic stroke receive a phone call from the neurology office staff within 3 business days of hospital discharge to schedule an appointment with a mid-level provider in the comprehensive stroke discharge clinic within 1-3 weeks. Eligibility for the clinic includes patients ≥ 18 years of age that are either discharged to home directly or discharged to home from inpatient rehabilitation. We performed a retrospective stroke database search of patients meeting this criteria from May 2015 to June 2016. Patients were excluded from the search if they had an inpatient stroke event.
Results: Of the 526 patients reviewed, 116 patients (22.1%) were seen in the comprehensive stroke discharge clinic. The average age of patients seen in clinic was 67 years and the average age of patients in the non-clinic group was 69 years. Approximately 12% of patients in each group received acute reperfusion therapy. There was only one 30 day related readmission in the clinic group, and fourteen 30 day related readmissions in the non-clinic group (0.86% versus 3.41%; 95% CI 0.12-4.99%). There were eight 30 day all cause readmissions in the clinic group, and forty-two 30 day all cause readmissions in the non-clinic group (6.90% versus 10.24%; 95% CI -2.12-8.81%).
Conclusion: The comprehensive stroke clinic model may reduce 30 day related readmissions for patients discharged to home. However, there were limitations to this study. The percentage of patients seen in the comprehensive stroke clinic was low. The goal is to improve the clinic follow up rate over the course of the next year. In addition, patients were excluded from the clinic if they were discharged to a skilled nursing facility, which is often associated with a higher readmission rate.