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

被引:68
作者
Allen, Kyle [1 ]
Hazelett, Susan [1 ]
Jarjoura, David [2 ]
Hua, Keding [2 ]
Wright, Kathy [1 ]
Weinhardt, Janice [1 ]
Kropp, Denise [3 ]
机构
[1] Summa Hlth Syst, Dept Med, Hlth Serv Res & Educ Inst, Akron, OH 44304 USA
[2] Ohio State Univ, Ctr Biostat, Columbus, OH 43210 USA
[3] Northeastern Ohio Univ Coll Med & Pharm, Rootstown, OH USA
关键词
Stroke care management; randomized trial; MULTIPLE END-POINTS; QUALITY-OF-LIFE; FOLLOW-UP; CLINICAL-TRIALS; REHABILITATION; OUTCOMES; INTERVENTION; SUPPORT; SCALE;
D O I
10.1016/j.jstrokecerebrovasdis.2009.02.002
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
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.
引用
收藏
页码:443 / 452
页数:10
相关论文
共 52 条
[1]  
ALLEN K, 2002, AM GER SOC ANN M AGS
[2]  
Allen K., 2004, Journal of Clinical Outcomes Management, V11, P707
[3]  
Allen Kyle R, 2002, J Stroke Cerebrovasc Dis, V11, P88, DOI 10.1053/jscd.2002.127106
[4]  
*AM HEART ASS, 1998, GERIATRICS, V53, P84
[5]  
*AM HEART ASS, 2007, HEART DIS STROK STAT
[6]   Can readmission after stroke be prevented? Results of a randomized clinical study: A postdischarge follow-up service for stroke survivors [J].
Andersen, HE ;
Schultz-Larsen, K ;
Kreiner, S ;
Forchhammer, BH ;
Eriksen, K ;
Brown, A .
STROKE, 2000, 31 (05) :1038-1045
[7]  
[Anonymous], BIOMETRICS
[8]  
Bisset AF, 1997, BRIT J GEN PRACT, V47, P787
[9]  
DAGOSTINO RB, 1998, ENCY BIOSTATISTICS
[10]  
DUNCAN D, 1999, AM HEART ASS COU WIN