Transitions of care clinic improves 30-day stroke outcomes

Use of a transitions of care clinic may reduce 30-day stroke readmissions, according to findings presented at the American Neurological Association annual meeting.

“Between 8% and 14.5% of stroke patients are readmitted within 30 days of discharge, on average, which obviously leads to worse patient outcomes,” Evan Kolesnick, MS, of Philadelphia College of Osteopathic Medicine, said during a virtual presentation. “Transitions of care clinic is an intervention which is designed for the patient to be seen shortly after hospital discharge in order to help them better manage their condition. It has been shown to reduce readmissions for various conditions by clarifying diagnosis and treatment, improving medication adherence and assuaging some patient concerns.”

Kolesnick and colleagues sought to determine whether a transitions of care (TOC) clinic reduced stroke readmission at Thomas Jefferson University Hospital (TJUH) in Pennsylvania. Specifically, they aimed to examine potential differences between 30-day stroke readmission with the TOC clinic and the top quartile of stroke-performing hospitals, as well as with TJUH’s general service. Other study aims included comparing in-person and telehealth TOC clinic results and identifying improvement areas via self-report measures of self-efficacy and perceived TOC value.

Researchers used ICD-10 codes that corresponded with ischemic stroke, hemorrhagic stroke and transient ischemic attack to identify 194 patients (92 in-person patients; 102 telehealth patients) for inclusion in quantitative analysis. In January 2019, patients received automatic scheduling for in-person TOC appointment 1 to 3 weeks after discharge. These transitioned to telehealth visits in February 2020. Kolesnick and colleagues collected readmission data via the electronic health record and delivered questionnaires via telephone within 6 months to assess self-efficacy and perceived value.

Readmissions occurred among seven (3.61%) patients, of whom one (1.09%) was seen in person and six (5.88%) via telehealth. Results of Chi-square analysis revealed no difference between in-person and telehealth performance. Chi-square comparisons showed no distinct difference between TOC and TJUH’s general service or the top quartile of stroke-performing hospitals in terms of 30-day readmissions. However, Kolesnick and colleagues noted the TOC clinic improved by 1.04% upon TJUH’s figure of 4.65% and 2.67% upon the top-quartile 2-year readmission figure of 6.28%.

The TOC clinic combined figure of 3.61% outperformed most recent CMS data (11.8%) between 2015 and 2016, according to the study abstract. The readmission rate was higher in 2020 compared with 2019, with possible causes related to effects of the COVID-19 pandemic on care. However, the pandemic did not appear to affect the number of monthly stroke discharges to home. Both in-person and telehealth groups reported satisfaction with TOC.

“Future directions include translating our findings into practical institution policy,” Kolesnick said during the presentation. “We also want to perform qualitative study of the barriers to telemedicine stroke clinic and make the platform more accessible to patients in the future. We intend to continue our data collection in the post-COVID era to determine if the pandemic confounded some of our findings.”