Introduction: Outpatient follow-up after a stroke is crucial for decreasing hospital readmissions, managing complications secondary to stroke, and preventing future stroke. Poor stroke follow-up rates have prompted further investigation at our comprehensive stroke center.
Aim: To identify factors associated with failed follow-up in stroke clinic after discharge from the Hospital.
Methods: A retrospective analysis was conducted on patients discharged with a diagnosis of acute ischemic stroke or TIA from July 1, 2016 to Dec 31,2016. Patients who expired or were enrolled in hospice by discharge were excluded. Chi-squared tests and two sample t-tests tests were performed to assess the associations of 90-day follow-up visit with patient demographics, clinical factors and discharge variables. Multivariate analysis was performed on variables with p value <0.10.
Results: In this 6 month period, 384 patients were identified, of which only 45% (174) followed up in the stroke clinic by 90 days. Differences were significant for insurance carrier [commercial (55%) vs Medicare (28%) and Medicaid (31%); p<0.001)], appointment scheduled at discharge (54% vs 32%, p<0.001), primary service [neurology (49%) vs medicine (13%); p<0.001)], mRS [less than 4 (52-58%) vs 4 (34%) vs 5 (0%); p=0.01], ambulatory status [independent (52%) vs assistance (44%) vs non-ambulatory; p=0.003], transition of care call [called-confirmed (79%) vs called-unreachable vs no documented call (41%)] and discharge disposition [Home (52%) vs acute care facility (38%) vs other (35%); p=0.006]. Insurance carrier, ambulation, transition of care call and appointment at discharge statuses remained significant in the multivariate analysis.
Conclusion: Multiple factors can predict clinic follow-up in stroke patients. These factors can be used to identify patients at risk of not completing stroke preventative services, to structure stroke discharge clinics, and proactively improve stroke follow-up rates.