Abstract Details

Title Strategies to Decrease Post Hospital Discharge Negative Outcomes for Patients with Neurological Diseases.

Topic Practice, Policy, and Ethics

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-072

Objective

To study the effect of mandatory 14-day post-discharge clinic follow-up on 30-day outcomes after discharge from the neurology service.

Background

In a retrospective study in 2016, our group noted a 23.7% rate of negative outcomes (30-day readmission, ER visits, death) following discharge from the inpatient neurology service. We identified post-discharge callback and timely scheduling of follow-up as important factors influencing outcomes. We hypothesized that readily implementable institutional protocols such as a post discharge 14-day clinic visit (RES) could decrease negative outcomes compared to standard of care (SOC) follow-up.

Design/Methods

60 adult patients discharged from the inpatient neurology service and living within 60 miles from clinic will be randomized to SOC or RES follow-up. We collected demographics, NIH stroke scale, Modified Rankin Scale, 3D-CAM (delirium), PDQ-9 Depression Index, Big Five Personality Inventory (BFI), and the EuroQol 5-dimensions scale (EQ-5D). Telephone questionnaires are done at 30 days and six months post-discharge. We present preliminary results for 24 subjects (9 RES and 15 SOC). Fisher’s exact tests were used for associations between categorical variables.

Results

Median time to clinic follow-up was 13 days for RES and 70 days for SOC. Six subjects (five RES, one SOC) attended follow-up within 14 days, and nine (four RES; five SOC) missed follow-up visits. Negative outcome occurred in 20.8% (n=5, two RES, three SOC). Of these, three (one RES; two SOC) missed their follow-up visit. Patients with lower EQ-5D scores (p=0.02) and higher mRS scores (p=0.07) were more likely to attend follow-up.

Conclusions

Post-discharge negative outcomes were not mitigated by mandatory follow-up within 14 days. Clinic no-shows have been identified as a problem as they accounted for 60% patients with a negative outcome. We caution that these are results from interim analysis, which needs to be validated at study completion.

Authors/Disclosures
Erin Smith, MD (University of Nebraska Medical Center) PRESENTER	Dr. Smith has nothing to disclose.
Krishna Mourya Galla, MD (Cleveland Clinic Epilepsy Center)	No disclosure on file
Harrison Lang	No disclosure on file
	No disclosure on file
Sachin Kedar, MD, FAAN (Emory University School of Medicine)	Dr. Kedar has nothing to disclose.
Matthew Rizzo, MD, FAAN (University of Nebraska Medical Center)	The institution of Dr. Rizzo has received research support from NIH.
Leslie J. Higuita, MD	Dr. Higuita has nothing to disclose.
	No disclosure on file
Nicholas Swingle, MD (Cleveland Clinic)	No disclosure on file
Fuad-al Ali, MD	No disclosure on file
Hae Young Baang, MD (Mount Sinai Health System)	Dr. Baang has nothing to disclose.
Kiel Woodward, MD (UNMC)	Dr. Woodward has nothing to disclose.
Brian Westerhuis, MD (Methodist Hospital)	Dr. Westerhuis has nothing to disclose.
Danmeng Wei, MBBS (Multicare Health System)	No disclosure on file
Jamison Hofer, MD (Jamison Hofer)	No disclosure on file
Kalyan Reddy Malgireddy, MD	No disclosure on file
Mohamed Taha, MD (Cleveland Clinic Foundation)	Dr. Taha has nothing to disclose.
Navya Joseph, MD (Bryan Physicians Network)	Dr. Joseph has nothing to disclose.
Praveen Hariharan, MD (University of Minnesota)	Dr. Hariharan has nothing to disclose.
Daniel A. Crespo, MD (Bryan)	Dr. Crespo has nothing to disclose.
Brian J. Villafuerte Trisolini, MD (University of Nebraska Medical Center)	Dr. Villafuerte Trisolini has nothing to disclose.
Navnika Gupta, MBBS	Dr. Gupta has nothing to disclose.
Matthew Purbaugh, MD (Bryan Physician Network)	Dr. Purbaugh has nothing to disclose.

��ɫ��

��ɫ��