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