Abstract Details

Title Disparities in Healthcare Interactions After Intracerebral Hemorrhage: Evidence from the REDUCE Trial

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-020

Background

Post-stroke follow up may be challenging for intracerebral hemorrhage (ICH) survivors. Characterizing patients’ interactions with the healthcare system post-stroke may identify opportunities for improved care delivery. We assessed healthcare interactions for ICH patients in the three-month period immediately after discharge.

Objective

To evaluate healthcare interactions for ICH patients in the three-month period immediately after discharge.

Design/Methods This analysis includes patients from one site of the REDUCE clinical trial, a pragmatic, randomized, open-label, multicenter trial comparing standard-of-care antihypertensive regimens vs. spironolactone-containing regimens in ICH survivors. All data were recorded from the electronic medical record for the three-month period after index ICH. A healthcare touch was defined as an in-person or virtual visit with a medical provider or a patient-initiated contact (phone calls or myChart messages from patients or patient representatives to providers). Blood pressure medication refills were recorded but not included as healthcare touches. A two-sample t-test was used to evaluate the relationship between age and race. A negative binomial regression was used to investigate predictors of healthcare interaction.

Results

61 patients from the REDUCE trial were included (37.7% female, average age 66.3 +- 11.6, median NIHSS 5.5). Seven patients (11.5%) had no healthcare touches, 21 patients (34.4%) had one to three healthcare touches, and 33 patients (54.1%) had four or more healthcare touches during this period. 48.9% of documented healthcare interactions were in-person visits, 9.0% were virtual visits, 37.8% were patient-initiated contacts, and 4.3% were blood pressure medication refills. African American patients were younger than white patients (average age 60.7 vs 70.4, p=0.001) and were 44% less likely to touch the healthcare system after ICH (p=0.042), adjusting for age, sex, and ethnicity.

Conclusions

This preliminary analysis suggests African American patients are less likely to interact with the healthcare system after ICH. Focused efforts on supporting this patient population navigating post-stroke care are needed.

Authors/Disclosures
Julia Zabinska PRESENTER	Ms. Zabinska has nothing to disclose.
Christopher L. Taylor	Mr. Taylor has nothing to disclose.
Emma S. Peasley (Yale School of Medicine)	Miss Peasley has nothing to disclose.
Dheeraj D. Lalwani (Yale University School of Medicine, Department of Neurology)	Mr. Lalwani has nothing to disclose.
Anna Schwartz	No disclosure on file
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Rohan Arora, MD	The institution of Dr. Arora has received research support from Bayer.
Carlos Mena-Hurtado (Yale University)	No disclosure on file
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Munachi N. Okpala, NP (McGovern Medical School-Division of Adult Neurology, Stroke Team)	Ms. Okpala has nothing to disclose.
Cheryl Bushnell, MD, MHS (Wake Forest School of Medicine)	Dr. Bushnell has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ZZ Biotech. The institution of Dr. Bushnell has received research support from PCORI. The institution of Dr. Bushnell has received research support from AHRQ. The institution of Dr. Bushnell has received research support from NIH/NINDS. Dr. Bushnell has received intellectual property interests from a discovery or technology relating to health care. Dr. Bushnell has received publishing royalties from a publication relating to health care.
Michael T. Mullen, MD (Temple University)	Dr. Mullen has received publishing royalties from a publication relating to health care.
Jordana Cohen (University of Pennsylvania)	No disclosure on file
Debbie Cohen	No disclosure on file
Steven R. Messe, MD, FAHA, FAAN (Hospital of the University of Pennsylvania)	Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novo Nordisk. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Terumo. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for WL Gore. The institution of Dr. Messe has received research support from WL Gore. The institution of Dr. Messe has received research support from Mallinkrodt. The institution of Dr. Messe has received research support from Biogen. Dr. Messe has received intellectual property interests from a discovery or technology relating to health care. Dr. Messe has received publishing royalties from a publication relating to health care. Dr. Messe has received personal compensation in the range of $500-$4,999 for serving as a Clinical Event Committee for the CONFORMAL left atrial appendage occlusion trial with Yale Cardiovascular Research Group.
Rachel Forman, MD (Yale Neurology)	Dr. Forman has nothing to disclose.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.