title: Reducing Readmissions After Stroke With a Structured Nurse Practitioner/Registered Nurse Transitional Stroke Program.
abstract: Our aim was to determine whether a standardized Transitional Stroke Clinic (TSC) led by nurse practitioners could reduce 30-day and 90-day readmissions for stroke or transient ischemic attack patients discharged home.
  
  
  
  Phase I consisted of nurse practitioners calling only high-risk patients discharged home within 7 days and performing an office visit within 2 to 4 weeks of discharge. Phase II consisted of all patients discharged home receiving both a 2-day follow-up phone call by a registered nurse and a follow-up visit with a nurse practitioner within 7 to 14 days. Differences in process metrics and readmissions across the 2 phases and overall were assessed. Increasing complexity with multiple chronic conditions (diabetes mellitus, coronary artery disease, and congestive heart failure) was represented in a continuous variable from 0 to 3. Multivariable logistic regression models for 30-day and 90-day readmissions were performed with adjustment for National Institutes of Health Stroke Scale (NIHSS) and previous hospitalizations.
  
  
  
  From October 2012 through September 2015, 510 patients were enrolled. From phase I to II, a higher proportion of follow-up calls were made and days from discharge to TSC decreased. Patients readmitted within 30 days were less likely to show for TSC visits (60.85% versus 76.3%; P=0.021). Multivariable modeling showed that TSC visit was associated with a 48% reduction in 30-day readmission (odds ratio, 0.518; 95% confidence interval, 0.272-0.986), whereas multiple chronic conditions and previous stroke/transient ischemic attack increased the risk. TSC visit did not impact 90-day readmissions.
  
  
  
  Evaluation in a nurse practitioner-led structured clinic is a model that may reduce readmissions at 30 days for stroke patients discharged home.
authors.affiliation: From the Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Christina
authors.initials: C
authors.lastname: Condon
authors.affiliation: From the Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lycan
authors.affiliation: From the Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC.
authors.forename: Pamela
authors.initials: P
authors.lastname: Duncan
authors.affiliation: From the Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC. cbushnel@wakehealth.edu.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bushnell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data*; D063868:Patient Outcome Assessment; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data*; D055502:Secondary Prevention / Q000706:statistics & numerical data*; D020521:Stroke / Q000628:therapy*; D000069341:Transitional Care / Q000458:organization & administration*
keywords: nurse practitioners; patient discharge; patient outcome assessment; patient readmission; quality improvement; risk factors; secondary prevention; stroke; transitional care