Disparities in Healthcare Interactions After Intracerebral Hemorrhage: Evidence from the REDUCE Trial
Julia Zabinska1, Christopher Taylor3, Emma Peasley4, Dheeraj Lalwani5, Anna Schwartz2, Guido Falcone2, Lauren Sansing2, Rohan Arora6, Carlos Mena-Hurtado2, Adam De Havenon4, Munachi Okpala7, Cheryl Bushnell8, Michael Mullen9, Jordana Cohen10, Debbie Cohen10, Steven Messe11, Rachel Forman12, Kevin Sheth13
1Department of Neurology, Yale School of Medicine, 2Yale School of Medicine, 3Frank H. Netter MD School of Medicine at Quinnipiac University, 4Yale University, 5Yale School of Medicine, Department of Neurology, 6Northwell Health, 7McGovern Medical School-Division of Adult Neurology, Stroke Team, 8Wake Forest School of Medicine, 9Temple University, 10University of Pennsylvania, 11Hospital of the University of Pennsylvania, 12Yale Neurology, 13Yale University Division of Neuro and Critical Care
Objective:
To evaluate healthcare interactions for ICH patients in the three-month period immediately after discharge.
Background:
Post-stroke follow up may be challenging for intracerebral hemorrhage (ICH) survivors. Characterizing patients’ interactions with the healthcare system post-stroke may identify opportunities for improved care delivery. We assessed healthcare interactions for ICH patients in the three-month period immediately after discharge.
Design/Methods:
This analysis includes patients from one site of the REDUCE clinical trial, a pragmatic, randomized, open-label, multicenter trial comparing standard-of-care antihypertensive regimens vs. spironolactone-containing regimens in ICH survivors. All data were recorded from the electronic medical record for the three-month period after index ICH. A healthcare touch was defined as an in-person or virtual visit with a medical provider or a patient-initiated contact (phone calls or myChart messages from patients or patient representatives to providers). Blood pressure medication refills were recorded but not included as healthcare touches. A two-sample t-test was used to evaluate the relationship between age and race. A negative binomial regression was used to investigate predictors of healthcare interaction.
Results:
61 patients from the REDUCE trial were included (37.7% female, average age 66.3 +- 11.6, median NIHSS 5.5). Seven patients (11.5%) had no healthcare touches, 21 patients (34.4%) had one to three healthcare touches, and 33 patients (54.1%) had four or more healthcare touches during this period. 48.9% of documented healthcare interactions were in-person visits, 9.0% were virtual visits, 37.8% were patient-initiated contacts, and 4.3% were blood pressure medication refills. African American patients were younger than white patients (average age 60.7 vs 70.4, p=0.001) and were 44% less likely to touch the healthcare system after ICH (p=0.042), adjusting for age, sex, and ethnicity.
Conclusions:
This preliminary analysis suggests African American patients are less likely to interact with the healthcare system after ICH. Focused efforts on supporting this patient population navigating post-stroke care are needed.