Reducing Readmission Rates By Improving Transitions Of Care For Stroke Patients In The Pre-Covid And Covid Eras

Introduction: Acute cerebrovascular disease ranks among the top causes of 30-day readmissions. Studies have shown that enhancing and streamlining transitions of care (TOC) for patients can improve readmission rates for many conditions. Our research explores the impact of in-person and telemedicine TOC stroke clinic on readmission rates at an urban comprehensive stroke center. Methods: Participants were identified by ICD-10 diagnoses corresponding with stroke or transient ischemic attack at Thomas Jefferson University Hospital (TJUH). Starting in January of 2019, an in-person TOC clinic visit with a vascular neurologist or nurse practitioner was automatically scheduled within 1-3 weeks for patients discharged to home. When coronavirus precautions began, these visits transitioned to telemedicine. Follow-up telephone surveys assessing self-efficacy, confidence and perceived value of TOC clinic were administered. Readmission statistics were collected from the TJUH electronic health record. Preliminary data analysis was performed in SPSS. Results: 208 individuals (113 in-person, 95 telemedicine) seen in TOC clinic were included in preliminary analysis. The 30-day all-cause readmission rate was 5.8% (12 patients). Of these readmissions, 2 were seen in the clinic (2.1%), and 10 were evaluated via telemedicine (8.8%). Chi Square revealed a between group difference (X2 = 4.318, p = 0.038). Participants in both the in-person group (u = 8.421, SD = 1.835) and telemedicine group (u = 8.100, SD = 1.875) considered TOC a valuable experience. Analysis of perceived TOC value did not differ between groups (t = 0.654, p = 0.515). Discussion: Stroke readmissions represent a significant source of morbidity, mortality and healthcare spending in the United States. Overall, there were fewer readmissions among TJUH TOC clinic patients compared to institutional and national 30-day stroke readmission rates. Understanding the relative impact of an in-person and telemedicine TOC stroke clinic will provide valuable information as healthcare systems navigate the post-COVID era

Stroke Centers of Excellence in the United States: Certification, Access and Outcomes

Introduction: Stroke is a leading cause of morbidity, mortality and healthcare costs in the United States. Evidence suggests that certified stroke centers have improved patient outcomes relative to non-certified hospitals. Our study explains the process, associated cost, quality and geographic proclivities of different certifying organizations. Methods: Data was collected from published literature, information on certifying organizations’ websites and through direct communication with representatives of The Joint Commission (TJC), Det Norske Veritas and Germanischer Lloyd (DNV-GL), and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of thrombectomy capable centers and comprehensive stroke centers was performed with the ArcGIS online tool. Results: Among the three certifying organizations, standards for recognition as acute, primary, thrombectomy capable and comprehensive stroke centers are not standardized. At the time of this review, there were 1406 TJC-certified stroke centers, 241 DNV-GL certified stroke centers and 66 HFAP-certified stroke centers in the United States. Cost for certification was similar with price scaled by complexity of capabilities. Quality metrics revealed a significantly higher rate of tPA administration and shorter door-to-needle time for TJC and DNV-GL centers than HFAP. All primary stroke centers exhibited improved in-hospital, 30-day and 1-year mortality when compared to non-stroke centers. Discussion: Despite lack of standardization of criteria between organizations, certification provides a mechanism for ensuring hospitals deliver higher standards of stroke care. Understanding variations in quality and scope of different organizations enables targeting of at-risk regions to maximize access and availability of care

Reducing Readmission Rates By Improving Transitions Of Care For Stroke Patients In The Pre-Covid And Covid Eras

Stroke is a substantial contributor to morbidity and mortality in the United States, with nearly 800,000 events annually. Discrepancies in demographic predilections support treatment as a public health issue. Standardization of treatment practices with the creation of certified stroke centers has led to improvements in acute stroke management and subsequent patient outcomes. However, 30-day stroke readmission rates remain among the highest for primary diagnoses. Improving continuity of care through a transitions of care (TOC) clinic shortly after hospital discharge has been shown to reduce 30-day readmission rates for numerous conditions. TOC clinic decreases misconceptions regarding diagnosis and treatment and helps instill self-efficacy. We employed this construct at Thomas Jefferson University Hospital (TJUH) to determine if TOC clinic is effective for reducing stroke readmissions. Self-reported measures of confidence and perceived TOC value were also collected. Patient data collected from January of 2019 through December of 2020 was included. Following coronavirus social distancing precautions, we began administering TOC visits via telemedicine in February of 2020. 194 patients met criteria for inclusion (92 in-person and 102 telemedicine). Our two-year combined readmission rate (7/194, 3.61%) improved upon TJUH’s (37/796, 4.58%) and the top quartile’s (2,222/34,325, 6.28%) performance during that period. Our findings support expanded implementation of TOC clinic for stroke and potentially for other similar conditions. Discrepancies in in-person (1/92, 1.09%) and telemedicine (6/102, 5.88%) readmission rates merit further exploration. Our study was limited by small sample size, particularly for survey measures. Continued data collection will improve statistical power for future updates

Abstract 1122‐000121: Integrated Geomapping Tool of Certified Stroke Centers in United States: A SVIN MT2020+ Committee Collaboration

Introduction: Stroke is a leading cause of morbidity, mortality and healthcare spending in the United States. Acute management of ischemic stroke is time‐dependent and evidence suggests improved clinical outcomes for patients treated at designated certified stroke centers. There is an increasing trend among hospitals to obtain certification as designated stroke centers. A common source or integrated tool providing both information and location of all available stroke centers in the US irrespective of the certifying organization is not readily available. The objective of our research is to generate a comprehensive and interactive electronic resource with combined data on all geographically‐coded certified stroke centers to assist in pre‐hospital triage and study healthcare disparities in stroke including availability and access to acute stroke care by location and population. Methods: Data on stroke center certification was primarily obtained from each of the three main certifying organizations: The Joint Commission (TJC), Det Norske Veritas (DNV) and Healthcare Facilities Accreditation Program (HFAP). Geographic mapping of all stroke center locations was performed using the ArcGIS Pro application. The most current data on stroke centers is presented in an interactive electronic format and the information is frequently updated to represent newly certified centers. Utility of the tool and its analytics are shown. Role of the tool in improving pre‐hospital triage in the stroke systems of care, studying healthcare disparities and implications for public health policy are discussed. Results: Aggregate data analysis at the time of submission revealed 1,806 total certified stroke centers. TJC‐certified stroke centers represent the majority with 106 Acute Stroke Ready (ASR), 1,040 Primary Stroke Centers (PSCs), 49 Thrombectomy Capable Centers (TSCs) and 197 Comprehensive Stroke Centers (CSCs). A total of 341 DNV‐certified programs including 36 ASRs, 162 PSCs, 16 PSC Plus (thrombectomy capable) and 127 CSCs were identified. HFAP‐certified centers (75) include 16 ASRs, 49 PSCs, 2 TSCs and 8 CSCs. A preliminary map of all TJC‐certified CSCs and TSCs is shown in the figure (1). Geospatial analysis reveals distinct areas with currently limited access to certified stroke centers and currently, access to certified stroke centers is extremely limited to non‐existent in fe States (for example: Idaho, Montana, Wyoming, New Mexico and South Dakota). Conclusions: Stroke treatment and clinical outcomes are time‐dependent and prompt assessment and triage by EMS directly to appropriate designated stroke centers is therefore critical. A readily available electronic platform providing location and treatment capability for all nearby certified centers will enhance regional stroke systems of care, including enabling more rapid inter‐hospital transfers for advanced intervention. Identifying geographic areas of limited access to treatment can also help improve policy and prioritize the creation of a more equitable and well‐distributed network of stroke care in the United States

Improving Post-Stroke Discharge For Individuals With Limited English Proficiency

Project AIM: Reduce readmissions among stroke patients who self-identify as preferring to receive care in a language other than English by 25% in one yea