A randomized trial testing the superiority of a postdischarge care management model for stroke survivors.

Abstract

OBJECTIVE:

We sought to evaluate whether comprehensive postdischarge care management for stroke survivors is superior to organized acute stroke department care with enhanced discharge planning in improving a profile of health and well-being.

METHODS:

This was a randomized trial of a comprehensive postdischarge care management intervention for patients with ischemic stroke and National Institutes of Health Stroke Scale scores greater than or equal to 1 discharged from an acute stroke department. An advanced practice nurse performed an in-home assessment for the intervention group from which an interdisciplinary team developed patient-specific care plans. The advanced practice nurse worked with the primary care physician and patient to implement the plan during the next 6 months. 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 0 SD for all except the stroke knowledge and lifestyle domain, which showed a significant effect of the intervention (P = .0003).

CONCLUSIONS:

Postdischarge care management was not more effective than organized stroke department care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a postdischarge knowledge gap.

• Authors: Kyle Allen, Susan Hazelett, David Jarjoura, Keding Hua, Kathy Wright, Janice Weinhardt, Denise Kropp
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) 2009 Nov-Dec Vol. 18 Issue 6 Pg. 443-52 ISSN: 1532-8511 [Electronic] United States
• PMID: 19900646 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Continuity of Patient Care
• Female
• Health Knowledge, Attitudes, Practice
• Home Care Services, Hospital-Based
• Humans
• Length of Stay
• Male
• Motor Activity
• Patient Care Team
• Patient Discharge
• Quality of Life
• Recurrence
• Risk Reduction Behavior
• Severity of Illness Index
• Stroke (mortality, physiopathology, psychology, therapy)
• Time Factors
• Treatment Outcome