To demonstrate the efficacy of an intervention implemented by a Comprehensive Stroke Center (CSC) in improving the proportion of post-stroke patients attending outpatient rehabilitation (i.e. physical therapy, occupational therapy, or virtual physical therapy) and reducing time to rehabilitation (i.e. number of days between discharge and date of first rehabilitation appointment).

Outpatient rehabilitation after hospital discharge is an essential component of stroke recovery. However, current nationwide utilization of outpatient rehabilitation post-stroke is low.

The intervention involved contacting post-stroke patients via telephone within 30 days after discharge to place an additional rehabilitation referral if the original appointment was not attended. We included adult subjects with a primary diagnosis of ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage who were discharged from the CSC (intervention site) and a nearby Primary Stroke Center (PSC) (control site) between 1/2016 and 8/2023. Pre-intervention data was from 1/2016 to 3/2019; post-intervention data was from 12/2019 to 8/2023. There was a ramp-up period from 3/2019 to 12/2019 that was excluded from analysis. Chi-square and Mann-Whitney U were used for before-after analysis. Multivariate logistic regression was used to control for insurance type, race, gender, age, and stroke type.

At the CSC, 1473/2455 subjects (60%) attended rehabilitation pre-intervention, and 1676/2537 subjects (66%) attended rehabilitation post-intervention (p<0.001). At the PSC, 848/1664 subjects (51%) attended rehabilitation pre-intervention, and 936/1769 subjects (53%) attended rehabilitation post-intervention (p=0.10). After controlling for covariates, multivariate logistic regression also demonstrated a significant increase in rehabilitation utilization post-intervention at the CSC (p<0.001), which was not observed at the PSC (p=0.15). Both sites showed significant (p<0.001) reductions in time to rehabilitation post-intervention (CSC: median=118 vs. 13 days; PSC: median=184 vs. 35 days), which may be attributed to significantly increased incidence of virtual visits (p<0.001), likely due to COVID-19.

Contacting patients via telephone after hospital discharge was associated with increased rehabilitation attendance.