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Specialized Outpatient Clinic vs Stroke Unit for TIA and Minor Stroke: A Cohort Study
Sidsel Hastrup1, Soren P Johnsen2, Martin Jensen2
1From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark. sidshast@rm.dk.
Objective:
To evaluate the effects of an outpatient clinic setup for minor stroke/TIA using subsequent admission of patients at high risk of recurrent stroke.
Methods:
We performed a cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Patients with stroke were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on nonprioritized outcomes: length of stay, readmissions, care quality (10 process-performance measures), and mortality. Patients with TIA were compared to contemporary matched, hospitalized controls. Following complete diagnostic workup, patients with stroke/TIA were classified into low/high risk of recurrent stroke ≤7 days.
Results:
We analyzed 1,076 consecutive patients, of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the patients with stroke were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n = 191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days; adjusted length of stay ratio 0.49; 95% confidence interval 0.33-0.71). Thirty-day readmission rate was 3.2% vs 11.6% (adjusted hazard ratio 0.23 [0.09-0.59]), and care quality was higher, with a risk ratio of 1.30 (1.15-1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the low risk category and not admitted experienced stroke within 7 days (0.6%).
Conclusions:
An outpatient clinic setup for patients with minor stroke/TIA yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
Classification Of Evidence:
This study provides Class III evidence that a neurovascular specialist-driven outpatient clinic for patients with minor stroke/TIA with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
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