Abstract Body: INTRODUCTION:
Neurology follow-up appointments are an essential part of post-stroke care, treatment and secondary stroke prevention. We aimed to determine factors contributing to patient attendance at neurology appointments and its impact on 90-day outcomes and readmissions.
METHODS:
Retrospective analysis on acute ischemic stroke (AIS) patients with care coordinated by a nurse navigator from 7 hospitals (January 2021-March 2024). Patients excluded if: died during index hospitalization, discharged to hospice or long term acute care hospitals, or had incomplete data. Primary outcome: factors contributing to patients attending post-discharge neurology appointments and secondary outcome: 90 day all cause readmission rates utilizing binomial stepwise logistic regression models. Ninety-day utility weighted modified rankin scale (UWmRS) evaluated using hierarchical linear regression. Sensitivity analyses examined secondary outcomes in patients discharged home. Subgroup analysis compared latency of patient follow up and association of 90 day all cause readmission rates using a binomial stepwise logistic regression. All outcome analyses were adjusted for potential confounding variables as identified in the univariate analyses.
RESULTS:
A total of 6121 AIS patients were evaluated, after exclusions 3450 were included in this study. Patients were more likely to attend a neurology appointment if discharged home,OR=1.47 [95%CI,1.23, 1.74],p<0.001, had private insurance,OR=1.53 [95%CI,1.27,1.84],p<0.001, had an active patient portal account,OR=1.65 [95%CI,1.41,1.94],p<0.001, or had a better baseline UWmRS,OR=4.18 [95%CI,2.58,6.76],p<0.001. Patients who attended appointments were less likely to be readmitted within 90 days,OR=0.42 [95%CI,0.36,0.50],p<0.001. After adjusting for baseline UWmRS and other confounding variables, patients who attended neurology appointments had better UWmRS at 90 days,B=0.17 [95%CI,0.15,0.19], SE=0.01,p<0.001. Similar results were seen in sensitivity analysis, all p<0.001. Subgroup analysis showed that longer delays to outpatient neurology follow-up led to increased likelihood of readmission,OR=1.005, [95%CI,1.001,1.009],p=0.01.
CONCLUSION:
Discharge home, private insurance, better baseline UWmRS and active patient portal accounts were key contributors to patient attendance at neurology follow up appointments which may have contributed to better UWmRS at 90-days. Avoiding delays to follow-up appointments may result in a decrease in readmissions.