Abstract W P297: The Electronic Stroke CarePath - An Integrated Approach to Stroke Care

Background: There is a continuous need to improve efficiency and quality of care. In response, the Electronic Stroke CarePath (ESCP) was developed for management of ischemic stroke patients. We describe the development, implementation and outcomes of the first 2 years of this initiative.Methods: The ESCP consists of care pathways for ischemic stroke that are integrated within the EHR (Epic) and includes systematic collection of patient-reported outcomes (PROs). Main components of the EHR integration included a navigation panel, the use of structured forms with elements that autopopulate templates, and clinical decision support. An external software platform was used to collect PROs. Inpatient mortality and length of stay (LOS) were compared before and after implementation in ischemic stroke patients and in 2 control groups: ICH and SAH patients, after adjustment for case-mix. Postdischarge functional outcomes of ischemic stroke patients were compared between the 1st 3 months of rollout and remainder of the study period.u003cbrResults: The ESCP was implemented in Sep 2010 and modified over the first 3 months. Data were analyzed from Jan 2011- Dec 2012. There were 1106 patients with mean age 66.2 yrs and admission NIHSS 5; 46.1% were women.There was a significant reduction in observed/predicted inpatient mortality after implementation of the ESCP in ischemic stroke patients (OR 0.59 [95% CI 0.42-0.83], but not in the control patients with ICH (OR 0.90 [0.59 - 1.38]) or SAH (OR 1.05 [0.67 - 1.65]). . Similarly, a significant increase in the proportion with LOS u003c predicted after ESCP implementation was seen only in ischemic stroke pts (51.4% vs 56.0%, p=0.047). Compared to those admitted within the 1st 3 mo of ESCP rollout, ischemic pts admitted in the remainder of the study period demonstrated nonsignificant improvements in degree of impairment (NIHSS, 3.9 to 2.7, p=0.059), IADLs (modified Rankin, 2.6 to 2.2, p=0.079) and physical function (SIS16, 67.8 - 76.0, p=0.084) at followup.Conclusion: Implementation of the ESCP is feasible and may be associated with a benefit in multiple different outcomes after ischemic stroke. This approach, which combines carepaths, HIT, and the systematic collection of PROs, may be an important strategy for optimizing stroke care in the future.