A Randomized Trial Testing the Superiority of a Postdischarge Care Management Model for Stroke Survivors
Received 5 December 2008; received in revised form 28 January 2009; accepted 11 February 2009.
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.
∗Health Services Research and Education Institute, Department of Medicine, Summa Health System, Akron, Ohio
†Center for Biostatistics, The Ohio State University, Columbus, Ohio
‡Community Health Sciences, Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, Ohio
Address correspondence to Susan Hazelett, RN, MS, Summa Health System, 75 Arch St, Suite G1, Akron, OH 44304.
Supported by the National Institute of Neurological Disorders and Stroke, grant number 5 R01 NS041333-02 and the Summa Hospitals Foundation. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke.
ABSTRACT