A Randomized Trial Testing the Superiority of a Postdischarge Care Management Model for Stroke Survivors

Abstract

Objective-To evaluate whether comprehensive post-discharge care management for stroke survivors is superior to organized acute stroke unit care with enhanced discharge planning in improving a profile of health and well-being.Methods-This was a randomized trial of a comprehensive post-discharge care management intervention for ischemic stroke patients with NIH Stroke Scale scores ≥1 discharged from an acute stroke unit. An Advanced Practice Nurse (APN) performed an in-home assessment for the intervention group from which an Interdisciplinary Team developed patient-specific care plans. The APN worked with the primary care physician (PCP) and patient to implement the plan over the next 6 months.Main outcome measures-The intervention and usual care groups were compared using a global and closed hypothesis testing strategy. Outcomes fell into 5 domains: 1) Neuromotor Function, 2) Institution Time or Death, 3) Quality of Life, 4) Management of Risk, and 5) Stroke Knowledge and Lifestyle.Results-Treatment effect was near zero standard deviations for all but the stroke knowledge and lifestyle domain which showed a significant effect of the intervention (p=0.0003).Conclusions-Post discharge care management was not more effective than organized stroke unit care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a post-discharge knowledge gap.

Patient with stroke: hospital discharge planning, functionality and quality of life

“…Thus, focused on clinical spheres and preparatory, prior or subsequent circumstances (terms used in the search: discharge planning; length of stay; after stroke), we can state, just like S 1 (7) , that the best health care results are obtained with more attention dedicated to the hospital-home transition process, with lower probability of re-hospitalization, despite having no direct impact on the QoL of the patient or caregiver. Moreover, S 2 (8) does not present significant differences in the five domains analyzed when comparing two replicable health care models; of these domains, only the one related to knowledge and lifestyle improved with the model, always ensuring discharge planning and follow-up. Another approach used in the studies was the participation of patients in the discharge planning and the relation with a perception of higher or lower HRQoL; S 3 (9) shows that such participation can be positively or negatively perceived.…”

“…Conclusion: early attention and care, training, evaluation and follow-up of patients and their families (caregivers) during hospitalization and after discharge, improve the quality of care provided to patients and reduces re-hospitalization. S 2 (8) Considering all domains analyzed related to stroke […], the effect size of the treatment was close to 0 […] for all of them, except for the domain "knowledge and lifestyle", which showed a significant effect resulting from the intervention (p=0.0003). Only the domain "knowledge and lifestyle" improved with the intervention, not demonstrating the superiority of any model ("comprehensive postdischarge care management") in relation to others ("organized acute stroke department care with enhanced discharge planning").…”

The Importance Of Transitional Care In Achieving Health Reform

“…Among the twenty-one studies, all but one 31 reported positive findings in at least one category. The authors of five additional studies 25,26,[32][33][34] concluded that their interventions were largely ineffective based on the absence of positive findings on primary outcomes.…”

Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia

“…[ [72] to 380 [55,72]; just under half of trials (11) [58,59,63,67,72,75], three studies chose measures of selfefficacy [53,54,74,79], one study chose a measure of depression as their primary outcome measure [73] and one study chose to measure proactive coping [77].…”