Abstract Details

Title Stroke and Transient Ischemic Attack Care Transitions Clinic: Providing Timely, Evidence-Based Care

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-019

Objective

To demonstrate the impact the of a Care Transitions Clinic (CTC) for patients with Stroke/TIA.

Background Patients seen in the ER and hospital for stroke/TIA have variable ambulatory follow-up. We implemented a protocol for timely, evidence-based ambulatory follow-up care.

Design/Methods

We conducted a retrospective review of patients seen in the CTC from November 2021-August 2022. The clinic serves patients with stroke/TIA within 3 weeks of hospital/ER discharge from our main campus and a community affiliate. Persons with established neurologists and those discharged to skilled nursing, long term acute care, and hospice services are excluded. In response to inpatient team requests for CTC appointments, designated clinic slots are released to discharge paperwork. A stroke PA sees the patient using a visit template and staffs the visit with a supervising stroke neurologist. The template focuses on etiologic work-up, secondary prevention optimization, lifestyle modification, education, incidental findings (e.g., intracranial aneurysm, echocardiogram abnormalities, thyroid and pulmonary nodules), and care coordination. Patients are provided follow-up with the supervising stroke neurologist to finalize etiologic diagnoses and secondary prevention plans.

Results Among 85 patients (59 from main campus, 26 from community affiliate) seen in CTC, mean age was 68 years and 39% were women. Diagnoses were: 61% ischemic stroke, 6% retinal event, 9% hemorrhagic stroke, and 24% TIA. The median time from discharge to CTC was 15 days (IQR, 11-23). For patients with ischemic events, >1 diagnostic test to ascertain etiology was ordered in 58% of visits, and appropriate antithrombotic and statin treatment was confirmed in 95%. Blood pressure was > 130/80 in 44%; these patients were offered 7-day blood pressure logs and dedicated hypertension management follow-up. Incidental findings were frequently addressed (total 49; >1 finding in 38% of visits).

Conclusions A team-based approach achieved its goal of connecting patients with stroke/TIA to outpatient care in a timely, standardized manner.

Authors/Disclosures
Shivani Daryani, PA (Weill Cornell Medicine) PRESENTER	Ms. Daryani has nothing to disclose.
Evan Kolesnick, DO (NewYork-Presbyterian Weill Cornell Medical Center)	Mr. Kolesnick has nothing to disclose.
Halina White, MD MA BA (Weill Cornell Medical Center)	Dr. White has nothing to disclose.
Saad A. Mir, MD (New York-Presbyterian Hospital/Weill Cornell Medical Center)	Dr. Mir has nothing to disclose.
Dana Leifer, MD (Weill Cornell Medical College)	Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Guidepoint Network. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum Partners. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Agilence. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Protembis. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Spigarelli Law Firm. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Anzalone Law Firm. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Finz & Finz. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for WIT Legal. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for DOAR. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Pirotti &Glaat. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Brown& Barron. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Morris Williams. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Meyers Evans. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Mandell & Schwartz. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Golomb & Honik. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Silver Glob & Teitell. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Abramson Brown Dugan. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Cochran Law Firm. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Hackensack Meridian Health. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for KAMMCO. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Kennedy Johnson. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Philips Parker. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Schochet . Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Walsh Woodard. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Wicker Smith. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Yoeli Gottlieb. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Steven Friedman. Dr. Leifer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Wilson Elser. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Ross Feller Casey. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Gentile & Associates. Dr. Leifer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Dansker and Aspromonte. Dr. Leifer has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Norman Steiner, Esq.. Dr. Leifer has stock in Landsdowne Labs. Dr. Leifer has stock in Neurotechnology Investors . The institution of Dr. Leifer has received research support from NIH.
Ava L. Liberman, MD (Weill Cornell Medicine)	Dr. Liberman has nothing to disclose.
Alan Z. Segal, MD, FAAN	Dr. Segal has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for Various Law Firms. Dr. Segal has received publishing royalties from a publication relating to health care.
Matthew E. Fink, MD, FAAN (Weill Cornell Medical Center)	Dr. Fink has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Relias LLC.
Hooman Kamel, MD (Weill Cornell Medical College)	Dr. Kamel has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Kamel has received personal compensation in the range of $50,000-$99,999 for serving as a Endpoint adjudication committee with Boehringer-Ingelheim.
Babak Navi, MD (Weill Cornell Medical College)	Dr. Navi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MindRhythm Inc. Dr. Navi has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for multiple medicolegal firms.
Neal S. Parikh, MD (Alnylam Pharmaceuticals)	Dr. Parikh has received personal compensation for serving as an employee of Alnylam Pharmaceuticals. Dr. Parikh has or had stock in Alnylam Pharmaceuticals.