Abstract Details

Title Factors Associated With Outpatient Neurology Clinic Follow-Up After Acute Stroke Hospitalization at a Large Public City Hospital

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-036

Objective

Identify factors influencing outpatient follow-up after acute stroke hospitalization.

Background Stroke recurrence is high in underserved populations. Outpatient follow-up after acute stroke hospitalization may improve adherence to recommended therapies for secondary stroke prevention. Ethnically and socioeconomically underserved communities, such as those treated in municipal healthcare systems, may face barriers to appropriate follow-up. We sought to identify factors associated with loss to follow-up in an underserved population.

Design/Methods We retrospectively reviewed electronic medical records of patients age 18 years or older discharged from Bellevue Hospital in New York City between 1/1/2017 and 6/20/2017 with an admission diagnosis of acute stroke and discharged with neurology follow-up. Data collected included demographics, preferred language, health insurance status, pre-admission functional status, stroke type, NIH Stroke Scale and modified Rankin Scale on admission and discharge, medical comorbidities, neurologic interventions, hospital complications, hospital discharge service and unit, medications prescribed upon discharge, and time of follow-up after discharge.

Results There were 94 stroke patients meeting criteria during the study period; 59 (63)% had any health insurance and 47 (50%) had a neurology outpatient visit within 180 days of discharge. There was no difference in demographics, in-hospital factors, medical comorbidities, stroke severity, and pre-admission functional status between patients who did and did not follow-up in neurology clinic. Only health insurance status was associated with neurology follow-up after acute stroke admission (51% without insurance vs. 59% with insurance attended follow-up, p=0.02). This relationship held after adjustment for common confounders (OR for insurance status 0.36; 95% CI, 0.13-0.97; p=0.04).

Conclusions We found health insurance status was associated with follow-up after hospital admission for acute stroke. However, as Bellevue Hospital does not require health insurance for outpatient care, further investigation is warranted to better understand barriers to follow-up in this subset of patients. Future work will involve interventions to improve outpatient follow-up in uninsured stroke patients.

Authors/Disclosures
Jonathan B. Tiu, MD (Hackensack University School of Medicine) PRESENTER	No disclosure on file
Alexander Allen, MD (NYU Center for Men's Health)	No disclosure on file
Jon Marc M. Finamore, MD (NYU Langone Medical Center)	No disclosure on file
Dixon Yang, MD (Rush University Medical Center)	Dr. Yang has nothing to disclose.
Sara K. Rostanski, MD (NYU School of Medicine)	Dr. Rostanski has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Individual law firms.

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