Abstract WP384: Feasibility Of Systematic Assessment Of 30-day Functional Outcomes After Stroke
Although functional status after stroke is widely considered important to measure, the feasibility of systematic assessment of functional status after stroke is unknown.
Objective: To determine the feasibility of obtaining 30 day functional status via phone call follow-up by a central group of nurses spanning multiple hospitals.
Methods: Prospective cohort study of patients admitted for stroke at 6 hospitals participating in the Ohio Coverdell Outcomes Evaluation Project. At 5 of these sites, patients were contacted by a central nurse 30-51days post discharge using a standardized protocol. In the remaining hospital, outpatient appointments were arranged for 30 days postdischarge. Patients who died inhouse or had hospice care were excluded from the follow-up protocol.
Results: Of the 699 patients in this cohort, 53.1% were female and 76.4% were white. Mean age was 68.5 yrs and mean admission NIHSS was 6.0. Phonecalls were successfully completed in 65.8% of the 486 eligible patients. There was no significant difference in completion rates among the 5 hospitals. Most common reasons for unsuccessful phone followup were: patient/family never reached 22.8% (111/486) and patient opted-out 6.4% (31/486). Factors associated with unsuccessful phone call included: DNR order (15.7% vs 8.7%, p=0.021), longer lengths of stay (median days 4 vs 3, p=0.015), higher discharge Rankin (2.9 vs 2.6, p=0.06), and IV tPA use (6.6 vs 2.8, p=0.05). There was no association between completed phone calls and discharge destination. In multivariable analysis, only age (OR 1.02, 95% CI 1.00 - 1.04) and no DNR (OR 1.96, 95% CI 1.00 - 3.83) were independently associated with successful phone follow-up. Post discharge clinic visits were completed in 52.9% (46/87) patients at the remaining site, and there were similar clinical associations with a completed visit.
Conclusion: Success of obtaining 30day phone follow-up is modest, occurring in 65.8% in 5 hospitals of varied types and patient populations. This has important policy implications for measuring stroke outcomes; systematic assessment of functional status post-discharge may require a combination of different methods to achieve high assessment rates.
- © 2012 by American Heart Association, Inc.