Abstract Number: Esoc2026a2269 Development and Validation of a Care Pathway Quality Indicator for Immediate Post-Stroke Orientation Inappropriateness Using French National Health Data: Deliqua-CNV Project

Abstract Background and aims Appropriate post-stroke orientation, considering stroke severity, handicap complexity, and socio-familial context, is essential to optimize recovery, allocate resources efficiently, and reduce complications. However, evaluation of orientation appropriateness remains limited. This study aimed to develop and validate a national indicator assessing non-appropriateness of immediate post-stroke orientation using French national health administrative data. Methods Indicator components were defined by constructing proxy measures for the five post-stroke referral criteria from the 2020 French guidelines: stroke severity, pre-stroke dependency, comorbidities, psychosocial difficulties, and limitations in community-based care. Validation involved three analyses: comparison with a gold standard dataset (Nouvelle-Aquitaine Stroke Observatory, 2019-2021, 18 hospitals) across all subpopulations studied (socioeconomic and clinical patient characteristics, hospitalization and hospital features, COVID-19 period), assessment of inter-hospital variability, and evaluation of temporal trends. Results The indicator demonstrated limited performance when compared with the gold standard in the overall population of 3,361 patients. However, its performance was good for patients with mild stroke (NIHSS 5): PPV=0.84, NPV=0.85, sensitivity=0.62, specificity=0.95. Results were consistent across stroke types and subpopulations. Among patients with mild stroke (n=1,475, 43.9%), 22.8% (95% CI: 23.3-24.2) had an immediately inappropriate post-stroke orientation: 23.0% (95% CI: 20.8-25.2) after ischemic stroke and 19.5% (95% CI: 11.2-28.0) after hemorrhagic stroke. No significant inter-hospital differences were observed, and referral practices remained stable during the COVID-19 period. Conclusions The indicator performs adequately for assessing inappropriate immediate post-stroke orientation in patients with mild stroke and offers a reliable tool to identify practices amenable to optimization, supporting improvements in post-stroke care quality. Conflict of interest FADOUA EL HAFA. NOTHING TO DISCLOSE