Background:
Follow-up care with stroke specialists can facilitate patient recovery. To improve care continuity post-stroke the Ohio Coverdell Stroke Program aimed to improve the proportion of hospitalized patients who had a follow-up appointment scheduled with specialty care (neurologist, neurosurgeon or neurology provider) prior to discharge.
Methods:
Data from Ohio Coverdell Stroke Program hospitals (N=48) were examined to determine the change in performance over a 12-month quality improvement initiative (quarters 1-2=baseline; quarters 3-4=active improvement phase). Admitted stroke patients of any type, planned for discharge home or to a rehabilitation or skilled nursing facility (post-acute care), and with a follow-up appointment ordered or recommended were included. Patients discharged in quarter 4 with and without an appointment scheduled were compared to identify targeted areas for continued improvement.
Results:
There were 3,920 stroke patients discharged home and 3,530 discharged to post-acute care. Of patients discharged home during the baseline period, 24.4% had a follow-up appointment scheduled before hospital discharge compared with 44.0% of patients in quarter 4 (80.3% improvement). Of patients discharged to post-acute care during baseline, 25.0% had a follow-up appointment scheduled compared with 40.2% of patients in quarter 4 (60.8% improvement). Improvement in the proportion of patients with a follow-up appointment was significant (p<0.001) for those discharged home and to post-acute care. Analysis of patient characteristics showed fewer appointments were scheduled in quarter 4 for patients discharged home who had a stroke type other than ischemic, were White, obese/overweight, or without a history of hypertension (p<0.05; no difference by age, stroke severity, or other co-morbidities). Among those discharged to post-acute care, fewer appointments were scheduled for patients with a NIHSS<5, White, with Medicare, or no history of coronary artery disease or obesity/overweight (p<0.05).
Conclusions:
Hospital performance with scheduling specialty care follow-up appointments improved significantly; however, there is room for continued improvement particularly with targeted patient sub-groups identified.
After discharge from hospital, where do we go? Follow-up of clients with mental illness and/or addiction: 30 days post-acute care.