The Neurohospitalist · 2025
Association of a Rapid TIA Inpatient Care Pathway with Quality Metrics at an Urban Academic Medical Center.
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Saline Austin, Pandya Varun, Balogun Oluwafemi, Islam Tanzina, Upadrasta Gautham, Okada Chihiro, Aziz Ali, Jadow Benjamin, Gordon Alexandra, Nagamalla Vineela, Sartori Alice, Rampersad Ida, Duncan Shelly Ann, Daza Ovalle Juan Felipe, Ovbiagele Bruce, Labovitz Daniel, Esenwa Charles
Аннотация
BACKGROUND: Transient ischemic attack (TIA) carries a high risk of stroke, necessitating immediate evaluation and risk modification. Patients in high-social determinants of health-burden communities often face barriers to rapid outpatient care, while inpatient admission can be resource-intensive and burdensome. We describe outcomes from a rapid TIA inpatient workflow (Rapid TIA) implemented at an urban academic medical center.
METHODS: A retrospective single institution observational study of 411 consecutive patients admitted for TIA over 4 years in the Bronx, NY. Rapid TIA had 3 phases: (1) initial neurologic evaluation, (2) hospital admission and expedited implementation of care, and (3) transition to outpatient specialty care. We compared 6 variables related to care delivery, as well as long-term outcomes, in the pre-implementation vs post-implementation groups.
RESULTS: The Rapid TIA program was associated with a significant improvement in overall care delivery measured using a composite process measure score from 3.2 (±1.1) pre-implementation to 3.8 (±1.1) post-implementation (OR 1.63, 95% CI: 1.35, 1.98, P = 0.001). Combined 1 year readmission rates for stroke/TIA, MI, and major bleeding events decreased from 15% (n = 28) in the pre-implementation group to 7% (n = 15) post-implementation (95% CI: 0.19, 0.74, P = 0.004).
CONCLUSIONS: Our study demonstrates that a rapid-inpatient TIA management pathway can significantly improve quality care and reduce readmissions. Rapid TIA may serve as a model for TIA care delivery in other underserved communities.
METHODS: A retrospective single institution observational study of 411 consecutive patients admitted for TIA over 4 years in the Bronx, NY. Rapid TIA had 3 phases: (1) initial neurologic evaluation, (2) hospital admission and expedited implementation of care, and (3) transition to outpatient specialty care. We compared 6 variables related to care delivery, as well as long-term outcomes, in the pre-implementation vs post-implementation groups.
RESULTS: The Rapid TIA program was associated with a significant improvement in overall care delivery measured using a composite process measure score from 3.2 (±1.1) pre-implementation to 3.8 (±1.1) post-implementation (OR 1.63, 95% CI: 1.35, 1.98, P = 0.001). Combined 1 year readmission rates for stroke/TIA, MI, and major bleeding events decreased from 15% (n = 28) in the pre-implementation group to 7% (n = 15) post-implementation (95% CI: 0.19, 0.74, P = 0.004).
CONCLUSIONS: Our study demonstrates that a rapid-inpatient TIA management pathway can significantly improve quality care and reduce readmissions. Rapid TIA may serve as a model for TIA care delivery in other underserved communities.