Outcomes of an EMR-Enabled Acute Ischemic Stroke Care Path in a Primary Stroke Center

Background: One major challenge in health care is to improve value, which is best measured at the disease or treatment level. Evidenced-based, standardized care has been proposed and studied as one potential method to drive this process. We hypothesize that enablement of the Acute Ischemic Stroke (AIS) Care Path within the electronic medical record (EMR) improves clinical outcomes of patients with acute ischemic stroke. Methods: We compared the length of stay (LOS), in-patient mortality, rate of hospital readmission within 30 days, NIH Stroke Scale (NIHSS) at admission in patients, and post-discharge modified Rankin Scale (mRS) with ischemic stroke in the periods before (January to December 2015) and after (January to December 2016) EMR-enablement of the AIS Care Path. Results: A total of 1,858 patients were diagnosed with acute ischemic stroke during the entire study period. Patients presented with more severe stroke symptoms, as evidenced by a higher NIHSS at admission in the post-intervention period (11.4 ± 0.7 vs 10.5 ± 0.7, p=0.05). There was no difference in LOS (5.2 ± 0.3 days vs 5.3 ± 0.2 days, p=0.41), and there was a significant reduction in rate of hospital readmission within 30 days of discharge (8.9 ± 2.0 vs 10.7 ± 2.0, p=0.05). There were trends toward decreased in-patient mortality (2.6 ± 0.7% vs 3.3 ± 1.5%, p=0.22) and improved functional outcomes (2.3 ± 0.3 vs 2.6 ± 0.4, p=0.20) after EMR-enablement of the AIS Care Path. Conclusion: EMR-enablement of the AIS Care Path, a means of further standardizing stroke care, was associated with lower readmission and trends toward lower mortality and improved functional outcomes.