1429 - A novel approach to increase outpatient rehabilitation utilization post-stroke

Objectives: Outpatient rehabilitation after hospital discharge is essential for stroke recovery. However, nationwide utilization of outpatient rehabilitation post-stroke is low. Our study aimed to demonstrate the efficacy of an intervention implemented by Kaiser Permanente Los Angeles Medical Center (KP LAMC) in improving the proportion of patients attending outpatient rehabilitation (i.e. attending physical therapy, occupational therapy, or virtual physical therapy) and reducing time to rehabilitation (i.e. number of days between discharge and date of first rehabilitation appointment).

Design: The intervention involved contacting post-stroke patients via telephone within 30 days after discharge to place an additional rehabilitation referral if the original appointment was not attended. We included subjects with a primary diagnosis of ischemic stroke, subarachnoid hemorrhage, or intracerebral hemorrhage who were admitted to KP LAMC (intervention site) and KP West Los Angeles (WLA) (control site) and discharged between 1/2016 and 8/2023. Subjects discharged to hospice were excluded. Pre-intervention data was from 1/2016 to 3/2019, and post-intervention data was from 12/2019 to 8/2023; there was a ramp-up period from 3/2019 to 12/2019 that was excluded from analysis. Chi-square, Mann-Whitney U, and difference-in-differences (DID) were used to analyze the data.

Results: At LAMC, 1473/2455 subjects (60%) attended rehabilitation pre-intervention, and 1676/2537 subjects (66%) attended rehabilitation post-intervention (p< 0.001). At WLA, 848/1664 subjects (51%) attended rehabilitation pre-intervention, and 936/1769 subjects (53%) attended rehabilitation post-intervention (p=0.10). Both sites showed significant (p< 0.001) reductions in time to rehabilitation post-intervention (LAMC: median=118 vs. 13 days; WLA: median=184 vs. 35 days), which may be attributed to significantly increased incidence of virtual visits due to COVID-19 across both sites (p< 0.001). However, with DID analysis, LAMC demonstrated a more significant reduction in time to rehabilitation compared to WLA (DID estimator=63 days, p< 0.001).

Conclusions: Contacting patients via telephone after hospital discharge was associated with increased rehabilitation attendance and reduction in time to rehabilitation.