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.
Key Words
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Article info
Publication history
Accepted:
February 11,
2009
Received in revised form:
January 28,
2009
Received:
December 5,
2008
Footnotes
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.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.02.002
Copyright
© 2009 National Stroke Association. Published by Elsevier Inc. All rights reserved.
