Abstract Body: Introduction: Managing post-acute hemorrhagic stroke care is complex and necessitates close follow-up and coordination. We aimed to identify factors contributing to neuroscience (neurology or neurosurgery) appointment attendance and the impact on readmission and 90-day function outcomes.
Methods: Retrospective analysis of hemorrhagic stroke patients with care coordinated by a stroke nurse navigator from one of seven hospitals between January 2022 and March 2024. Patients were excluded if: discharged to a long-term care facility or hospice, expired prior to discharge or had incomplete data. Primary outcome evaluated variables contributing to attendance of a neuroscience appointment post-discharge and secondary outcome: examined 90-day all cause readmission using binomial logistic regressions. Ninety-day modified Rankin Scale (mRS) evaluated functional outcomes analyzed using a proportional odds logistic regression. Subgroup analysis compared latency to neuroscience appointment. Outcome variables were adjusted for potential confounding variables based on univariate analyses. Secondary outcomes were also adjusted for patients discharged to home.
Results: A total of 914 patients were evaluated and after exclusions 424 were included in this study. Hemorrhagic patients were more likely to attend a clinic appointment when: had an active patient portal, Odds Ratio (OR)=2.49 [95% Confidence Interval (CI) 1.49, 4.17], p=0.001 or discharged home OR=2.11 [95%CI 1.17, 3.80], p=0.01 and less likely to attend with higher premorbid mRS OR=0.59 [95%CI 0.46, 0.74], p<0.001. Patients attending appointments were less likely to be readmitted: OR=0.50 [95%CI 0.30, 0.85], p=0.01 and more likely to shift to the next (better) mRS at 90 days: OR=4.25 [95%CI 2.70, 6.99], p<0.001. Longer delays in returning to the clinic post-discharge resulted in a greater likelihood of readmission within 90 days, OR=1.01 [95%CI 1.00, 1.02], p=0.04. Outcome data was similar for patients with intracerebral hemorrhage and subarachnoid hemorrhage all p<0.05.
Conclusion:
Prehospital mRS, post hospital disposition and mychart activation were key contributors to patient attendance at a neuroscience follow up appointment.