Abstract TP347: The Stroke Transitions Education and Prevention (STEP) Clinic: A Learning Healthcare Model for Post-Stroke Care

Background and Purpose: The STEP clinic was established to provide post-acute care for stroke patients. In this learning healthcare model, optimization of processes is enriched by evaluation of patient outcomes and patient and provider feedback. Trainee education and clinical trial recruitment are key. We describe the approach, patient population, and outcomes. Methods: STEP patients are assessed by a multidisciplinary care team within 6 weeks post-hospitalization. Patients complete depression, fatigue, and sleep apnea questionnaires. The team develops a personalized treatment and follow-up plan and provides risk factor counseling and education. We obtained data from the STEP clinical registry for patients enrolled from 10/2014 to 05/2017. Results: Among 605 enrolled patients following up at median of 47 days, 55% were male, mean age was 62.2 (SD 14.3), and stroke types included 76% ischemic/transient ischemic attack and 20% intracerebral hemorrhage. By race, 45% were non-Hispanic white, 27% non-Hispanic black, 19% Hispanic, and 3% Asian. Initial blood pressure (BP) was controlled for 66% (<140/90 mmHg) with medications adjusted for 9%. BP control was maintained at 67% among assessed patients. Of 91% completing a depression screen, 24% had at least moderate depression, and 22% were maintained or initiated on an antidepressant. Of 92% patients completing an epworth sleepiness scale, 36% scored >9 (abnormal), and 27% were sent for a sleep study. A total of 38 trainees rotated through the clinic and 91 patients were enrolled in studies. Four novel trials, 3 randomized clinical trials and 1 observational study, were derived from the clinic. Conclusions: The STEP clinic represents a learning healthcare model for post-stroke care. Learning healthcare models for post-stroke care are feasible and may be an effective approach to secondary and tertiary prevention.