Quality improvement: improving primary care follow-up for stroke/TIA patients
Khan MS, Osman G, Mahajan A, Alshammaa A, Kananeh M, Butt R, and Walbert T. Quality improvement: improving primary care follow-up for stroke/TIA patients. Neurology 2018; 90(15 Suppl 1):P5.245.
Objective: Our goal was to increase compliance of post stroke/TIA patients to have a 50% show rate to PCP clinic within a 5-week period. Background: Primary care physician (PCP) visits are essential for monitoring stroke risk factors such as diabetes, hypertension. These risk factors are shown to be poorly controlled in patients who miss clinic visits, which results in worse outcomes. A patient's poor understanding of outpatient scheduling following inpatient discharge is a factor which hinders compliance with follow up visits. Earlier outpatient follow-up and improved education has been shown to prevent readmissions among patients with stroke. Design/Methods: Inclusion criteria were patients with diagnosis of stroke or transient ischemic attack (TIA) with a PCP within the Henry Ford Health System. Patients were discharged from the stroke unit to their home or inpatient rehab. In a pre-intervention group, we assessed compliance of patients following up with their PCP within 5 weeks following discharge. Our hypothesis suggests that arranging for follow up appointments with the patient's PCP/Neurologist prior discharge will improve follow up within 5 weeks of discharge. The importance of close follow up after Stroke or TIA was also discussed with patients prior to discharge. Results: During one month of preintervention data collection, 49 patient charts were reviewed. Only 13 (26.53%) of those patients were noted to have followed up with their PCP within 5 weeks. Following our intervention, patients' follow up with their PCP increased to an average of 51% compliance. Data was tracked over an 11 month period. Conclusions: Pre-arranging follow up for stroke patients with their PCPs is an effective intervention to improve compliance in stroke patients. A subset of patients with logistical difficulty in keeping appointments was identified: Patients undergoing sub-acute rehab were less likely to follow up. Further research should focus on addressing factors impeding outpatient follow up.
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