Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations

Abstract

In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person’s recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.

Health Equity and Actionable Disparities in Stroke: 2022 Update

“…Sarfo et al make a case for both the efficacy and cost-effectiveness of polypill interventions for cardiovascular disease prevention; however, highlight the importance of using implementation science to determine barriers to systematic implementation of such interventions. The reviews by Reeves et al, 2 Sharrief et al 3 , and Sarfo et al highlight several of the considerations in Kapral’s 1 framework for the future of research addressing stroke inequities. Specifically, in all interventions discussed—care transitions, telehealth, and polypills—social determinants of health need to be addressed or considered to reduce inequities.…”

“…First, Kapral, recipient of the 2022 Edgar J. Kenton III award for her contributions to stroke inequities research, provides astute guidance on key considerations in future research to address inequities in stroke. Reeves et al 2 provide insight into the existing evidence evaluating care transition interventions to improve outcomes and reduce inequities in stroke. Sharrief et al 3 summarize the rationale for using telehealth interventions in stroke to reduce inequities and provides practical advice on how to address barriers to telehealth interventions for historically disenfranchised populations.…”

“…Most have not been efficacious in achieving their primary outcome, but several studies have shown significant differences in secondary outcomes or subgroup analysis. Reeves et al 2 stress the importance of engaging community members in co-designing interventions to ensure that interventions are patient-centered, culturally tailored, and meet the needs of the communities involved. Digital interventions, including eHealth solutions, have the potential to address inequities, but care should be taken not to exacerbate the digital divide.…”

“…Digital interventions, including eHealth solutions, have the potential to address inequities, but care should be taken not to exacerbate the digital divide. Finally, Reeves et al 2 emphasize that while we are determining the optimal care transitions interventions to improve outcomes and reduce inequities, it is critical to ensure we continue to provide patient-centered, coordinated care with shared decision-making, robust information exchange, and promotion of stroke survivors’ self-management skills.…”

“…Established in 2020, it is the first annual multidisciplinary scientific forum focused on inequities in cerebrovascular disease, with the overarching goal of accelerating translation of research findings to practice, to reduce inequities. The symposium aims are (1) to provide opportunities for researchers from diverse scientific and professional disciplines to discuss cuttingedge research about inequities in stroke and identify knowledge gaps for further research; (2) to accelerate collaborations among stakeholders interested in addressing stroke inequities; (3) to provide career development opportunities for underrepresented in medicine trainees and junior investigators, and (4) to disseminate knowledge generated from the symposium.…”