Abstract 60: Patient Engagement With Stroke Nurse Navigator Reduces Readmissions

Objective: We aimed to evaluate whether the level of engagement with stroke nurse navigators affected readmission rates and outcomes in acute ischemic stroke (AIS). Engagement is defined as a phone or virtual encounter between the patient and the navigator. We further defined the level of engagement as: low engagement < 5 encounters or high engagement ≥ 5 encounters in 90 days. Methods: Multicenter retrospective analysis of AIS patients with admission from January 2021 to April 2022. Patients were excluded if: died during index hospitalization, discharged to hospice or had incomplete data. Our primary outcome was readmission within 90 days analyzed with a binomial logistic regression. Secondary outcomes were: attendance of neurology appointments, recurrent neurologic symptoms, both assessed with a binomial logistic regression, and functional outcome as defined by utility weighted modified Rankin Scale (UWmRS) at 90 days post discharge which we used a hierarchical multiple regression analysis. Sensitivity analysis examined outcomes in patients who were discharged to home. Results: Stroke nurse navigators enrolled 2,584 patients. 2,035 patients were analyzed. Of the 2,035 patients, 1195 (58.7%) were highly engaged and 840 (41.3%) were less engaged. Highly engaged patients were less likely to be readmitted within 90 days compared to less engaged patients (20.9% vs. 33.3%), adjusted odds ratio (aOR)= 0.57 [95%CI, 0.46 - 0.72], p< 0.001. Additionally highly engaged patients compared to less engaged patients were: more likely to attend neurology follow-up appointments (64.6% vs. 43.3%), aOR= 1.94 [95%CI 1.59 - 2.37], p<0.001; less likely to have a recurrent neurologic event (6.5% vs. 9.3%), aOR=0.56 [95%CI 0.39 - 0.81], p = 0.002 and had greater functional ability at 90 days (7.9±2.6 vs. 5.4±4.0), b=0.98 [95%CI, 0.71, 1.25], p<0.001. Sensitivity analyses suggested that trends found in primary and secondary analyses were similar when examining only patients discharged to home, all p<0.05. Conclusion: Patients with AIS actively engaged with a stroke nurse navigator were found to have better outcomes and less readmissions through 90-days of post-discharge care irrespective of discharge location.