Abstract Body: Background: Maximizing long-term home time (HT) for acute ischemic stroke (AIS) patients has patient-centered and health-system benefits. We evaluated the influence of early (30-day) post-acute care (PAC) pathways on 1-year HT.

Methods: We analyzed a cohort of Medicare AIS patients at a 7-hospital stroke certified health system (2016 to 2020). Clinical data extracted from an EMR-driven registry were linked to PAC utilization information retrieved from a CMS Qualified Entity with ≥80% data for the Texas state population (including 100% of Medicare Fee-for-Service). All claims within 1 year of hospitalization were collated and grouped into corresponding care pathways. One-year HT (i.e., number of days at home across 1-year period) was calculated utilizing discharge dates from various healthcare settings. Low HT was defined as <50% of days at home. Event flags at 30-day (30-D) or 1-year (1-YR) post-discharge for inpatient rehab (IR), institutionalized care (skilled nursing, hospice), hospital readmission (HR), and death were created. Random forest (RF) classification and regression models were built to evaluate predictors of 1-YR outcomes (HR, death, and HT). Factors associated with 1-YR outcomes were evaluated via multivariate logistic regression. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results: A total of 3,064 AIS survivors with matched claims data were analyzed (median, IQR age: 77, 70-84 years; 55.8% female; 63.6% White; 20.0% Black; 9.7% Hispanic). HR rates at 30-D and 1-YR post-discharge were 16.1% and 45.9%; 30-D and 1-YR mortality rates were 10.7% and 26.0%. Figure 1 depicts patient frequency distributions across the 1-YR spectrum of home time. The relative importance of all features included within each RF model is shown in Figure 2. In addition to known predictors (stroke severity, age, comorbidities), 30-D care pathways (IR and HR) were also strong contributors to 1-YR outcomes. Post-acute IR was associated with decreased 1-YR mortality (aOR, CI: 0.57, 0.46-0.71) and lower likelihood of low HT (aOR, CI: 0.62, 0.50-0.76) (Figure 3). HR was associated with greater than two-fold mortality risk (aOR, CI: 2.73, 2.14-3.48) and higher likelihood of low HT (aOR, CI: 2.37, 1.88-2.99).

Conclusion: Our analysis underscores the importance of early PAC pathways for extending favorable recovery time at home. Interventions aimed at optimizing rehab resources and minimizing institutionalized care may improve health trajectories.