Introduction: Immediate post-stroke discharge destination is easily determined. Long-term disposition and healthcare utilization is more difficult to study due to the variability in outcomes, including multiple transitions for many patients. We sought to longitudinally determine place of residence and physician follow-up in a defined population.
Methods: Our population-based stroke epidemiology study retrospectively ascertains hospitalized ischemic and hemorrhagic strokes via ICD-9/10 codes within 5 counties in the greater Cincinnati metropolitan region. For this study, post-stroke dispositions and physician encounters for ischemic strokes that presented to one healthcare system of 4 community hospitals from 1/1/15 to 12/31/15 were analyzed by mining patient electronic medical records (EMRs). Disposition was analyzed at discharge, 3, and 6 months post-stroke, and outpatient and emergency department (ED) visits, and hospital admissions, were tabulated at 3, 6, and 12 months. The first post-discharge physician encounter was also assessed, and time to encounter was considered. Previous analysis has shown that this network is relatively self-contained with few transfers to other health systems, making it ideal for this study.
Results: See figure for details. Only 17% of the cohort saw a neurologist within 1 year, whereas 73% saw a primary care provider (PCP) and 37% saw a cardiologist. PCPs accounted for 56% of the first post-stroke encounters. Over 24% of the cohort visited the ED or were re-hospitalized before having their first outpatient visit.
Conclusions: In a community setting, PCPs are responsible for the majority of post-stroke care, and fewer than one in five patients sees a neurologist post-stroke. Future work will include additional analysis to determine whether the results from this health system are consistent with others in our region.