LAUSR

Objective: To evaluate whether the level of engagement of hemorrhagic patients with nurse navigators affected readmissions and outcomes. Methods: Retrospective multicenter study of hemorrhagic stroke patients from seven hospitals between January 2021 and April 2022. Patients who died or discharged to hospice were excluded. Navigators contacted patients at scheduled intervals to review care, medications, confirm appointments and provide education. Engagement was defined as a phone or virtual encounter with patient: low (< 5 encounters) or high (≥ 5 encounters) during 90-day epoch. The primary outcome examined readmission within 90 days using a binomial logistic regression. Secondary outcomes included: attendance of neurology visit; new or worsening symptoms and 90 day modified Rankin Scale (mRS) analyzed with binomial logistic and ordinal regressions. Sensitivity analysis examined outcomes in patients discharged to inpatient rehabilitation or skilled nursing. Multivariable analyses were adjusted for potential confounding variables. Results: We enrolled 368 hemorrhagic stroke patients, of which, 281 were included; 217 (77.2%) intracerebral hemorrhage and 64 (22.8%) subarachnoid hemorrhage. There were 144 (51.2%) less engaged and 137 (48.8%) highly engaged patients. Highly engaged patients were less likely to be readmitted compared to less engaged patients (23% vs. 42%), adjusted odds ratio (aOR) = 0.49 [95%CI, 0.28 - 0.87], p= 0.02. There was no difference in engagement and attendance of appointments, aOR = 1.73 [95%CI, 0.96 - 3.11], p = 0.07 or new neurologic events, aOR = 0.52 [95%CI, 0.25 - 1.08], p = 0.08. Highly engaged patients had less disability at 90 days compared to less engaged patients, median mRS = 2 (IQR, 1 - 3) versus 3 (IQR, 2 - 5), aOR = 0.49 [95% CI, 0.30 - 0.81], p = 0.006. Highly engaged patients discharged to a health care facility were also less likely to be readmitted and had less disability at 90 days compared to less engaged patients, all p< 0.05. Conclusions: Patients were found to have lower readmission rates and less disability at 90 days if they had a high level of engagement with the nurse navigators.