Abstract WP169: Inpatient Stroke Admission Associated With Changing Outpatient Home Health System

Introduction: Interhospital transfer for ischemic stroke is increasingly common, resulting in rural patients receiving treatment outside of their local health system. It is unclear if admission for stroke has an impact on where patients seek healthcare in the future. This analysis evaluates the likelihood that a patient changes their outpatient home health system after being admitted to a different health system for ischemic stroke. Methods: Using a 5% sample of Medicare Fee-for-Service (FFS) claims, we identified patients admitted for ischemic stroke from 2017 to 2021. We excluded patients <66 years old, who died <18 months after stroke, or who were not continuously enrolled in Medicare FFS for 1 year prior to and 2 years following the index stroke. We assigned each hospital to a health system using the Agency for Healthcare Research and Quality’s (AHRQ’s) Compendium of US Health Systems. We assigned outpatient specialist visits to a health system using office-based claims, CMS facility affiliation data, and AHRQ’s Compendium. The health system with which the majority of a patient’s specialists were affiliated in the year prior to stroke was defined as that patient’s “Pre-stroke home health system”. This process was repeated two years after the stroke to define the “Post-stroke home health system”. We conducted logistic regression to examine the odds that a patient admitted for stroke outside their home health system would change their home health system after admission. Results: We identified 21,087 patients hospitalized for ischemic stroke from 2017 to 2021. The mean age of the population was 77.9 years old, 56% female, 86% non-Hispanic White, and 68% urban. 13% received thrombolytic, 4% thrombectomy, and 10.2% were transferred for ischemic stroke admission (Table 1). 51% of patients were admitted outside their home health system and only 49% of patients had the same home health system before and after their stroke (Table 2). Patients admitted for ischemic stroke outside their home health system were significantly more likely to change their home health system after the stroke [unadjusted OR 5.03, 95% CI: 4.687-5.398, p<0.0001; adjusted OR 5.088, 95% CI: 4.687-5.398, p < 0.0001] (Table 3). Conclusion: As admission for ischemic stroke outside the home health system is associated with changing home health systems, transfer for stroke care could result in the siphoning of patients away from smaller rural health systems.