To identify factors associated with poor post-discharge follow-up compliance in stroke patients.

Approximately 795,000 strokes occur in the United States each year. Following a stroke, there is observable cognitive and functional impairment, as well as mood disturbances, that persist beyond hospital discharge. Follow-up care has been shown to improve functional outcomes in stroke patients. However, ensuring patient compliance with follow-up appointments is a challenge; clinicians report follow-up compliance rates to be around 1 in 3. Therefore, it is imperative to identify factors that may affect compliance to follow-up and develop tools to improve follow-up rates in stroke patients.

We conducted a retrospective chart review on patients discharged from the stroke unit at Saint Louis University Hospital from January 2018 to May 2018. Patients were determined to be compliant to follow-up if they attend their first follow-up appointment post-discharge; we obtained appointment records through hospital charts. Demographic data was collected, as well as data on stroke characteristics, discharge process, insurance type, and details about the follow-up appointment. Chi-squared tests were used to compare percent compliance across categorical factors, and logistic regressions were used to determine predictability of compliance using continuous factors. Significant associations identified in analyses will be used to guide development of a post-discharge protocol to improve patient compliance to follow-up.

There was a significant association between discharge location and follow-up compliance, χ²(2, n=177)=7.96, p=0.02. 64.4% of patients discharged home returned for follow-up, compared to 49.2% of patients discharged to rehabilitation and 36.7% of patients discharged to other facilities. Furthermore, high NIH Stroke Scale scores at admission predicted lower compliance to follow-up (OR=0.948; 95% CI: 0.90-1.00, p=0.03).

From our preliminary analysis, we have identified discharge location as a factor to address in our development of a post-discharge protocol to improve follow-up rates in stroke patients.