Association of a Rapid TIA Inpatient Care Pathway with Quality Metrics at an Urban Academic Medical Center.

Abstract

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.