Integration in stroke services: the challenges for primary and community care services

Baeza, Juan; Fraser, Alec; Boaz, Annette

doi:10.1080/17571472.2013.11493368

Cited by 3 publications

(4 citation statements)

References 13 publications

(9 reference statements)

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“…A stroke system of care for effective and efficient patient care requires an effective integration of its component services. [33][34][35][36] Within the current health care infrastructure, achieving such integration poses a significant challenge across the health care entities because it requires assessing various alternatives in terms of benefits and risks before committing real resources. 33 Although stroke recognition by EMS providers in the field is a critical step in stroke care, accurate stroke identification is challenging because of the low sensitivity and specificity of prehospital stroke assessment tools.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

2020

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Background We quantify the impact of implementing a stroke system of care requiring transport of individuals believed to have stroke to a primary stroke center, in rural and urban settings, based on time from symptom recognition to treatment, probability of receiving treatment within 3 hours of stroke onset, and probability of overcrowding. We use Indiana as an example. Methods We used discrete-event simulation to estimate outcomes for 2 scenarios: stroke system of care with enabling technology (mobile stroke unit, stroke team expansion) and stroke system of care with no enabling technology, as compared with the status quo. We considered patient flow from symptom recognition to treatment. Patient locations and stroke events were generated for the 92 Indiana counties in Indiana, subdivided into 1009 locations. We considered time from emergency medical service (EMS) arrival at onset to treatment, probability of tissue plasminogen activator administered within 3 h of onset, and percentage of patients admitted beyond the occupancy level at the comprehensive stroke center. Results Results varied by urbanicity. Under no enabling technology, having a stroke system of care improved outcomes for individuals in urban and suburban settings. However, in rural settings, the implementation of stroke system of care guidelines decreased the average rate of treatment within 3 h of stroke onset and increased the EMS arrival to treatment times compared with sending the individual to the closest provider. Enabling technologies improved outcomes regardless of setting. Discussion Geographic disparities tend to increase the number of transfers, decrease the rate of treatment within 3 h of onset, and increase transit time. This could be overcome through federal and state initiatives to reduce quality gaps in stroke care in rural settings and promote care with dedicated stroke wards.

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Section: Discussionmentioning

confidence: 99%

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

2020

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“…Researches address the burden of the individuals and families of the society and the health care systems concerning post-stroke patients who have disabilities and often can no longer reintegrate into socio-professional activities. Therefore, more and more emphasis is placed on developing facilities to speed patients’ physical rehabilitation after stroke [ 24 , 25 , 26 ]. Therefore, this study aims to determine the effectiveness and particularities of the use of VR associated with MT in the recovery of the LE of patients with post-stroke sequelae, compared to a standard physiotherapy program, as a novel approach in LE post-stroke rehabilitation, to contribute to the amendment of the efficient techniques and methods used in post-stroke rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

Miclăuş

Roman

Henter

et al. 2021

IJERPH

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More innovative technologies are used worldwide in patient’s rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen’s d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen’s d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen’s d 0.693), muscle strength (p < 0.05, Cohen’s d 0.924), lower extremity functionality (p < 0.05, Cohen’s d 0.984) and postural balance (p < 0.05, Cohen’s d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.

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“…C linical and organizational integration of the emergency department and in-hospital stroke care services has led to significant gains in the management of acute stroke. 1 By contrast, coordination and continuity between hospital stroke care and ambulatory care follow-up have received less attention in policy, research, or practice. Inadequate continuity and coordination can have a profound impact on outcomes for the 50% of stroke patients who are discharged home following an acute stroke hospitalization.…”

mentioning

confidence: 99%

“…Clinical and organizational integration of the emergency department and in-hospital stroke care services has led to significant gains in the management of acute stroke 1. By contrast, coordination and continuity between hospital stroke care and ambulatory care follow-up have received less attention in policy, research, or practice.…”

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confidence: 99%

Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA

et al. 2022

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Background and Objectives: We examined transitional care management within 90 days and 1 year following discharge home among acute stroke and transient ischemic attack patients from the Comprehensive Post-Acute Stroke Services (COMPASS) Study, a cluster-randomized pragmatic trial of early supported discharge conducted in 41 hospitals (40 hospital units) in North Carolina, United States.Methods: Data for 2262 of the total 6024 (37.6%; 1069 intervention and 1193 usual care) COMPASS patients were linked with the Centers for Medicare and Medicaid Services fee-for-service Medicare claims. Time to the first ambulatory care visit was examined using Cox proportional hazard models adjusted for patient characteristics not included in the randomization protocol.Results: Only 6% of the patients [mean (SD) age 74.9 (10.2) years, 52.1% women, 80.3% White)] did not have an ambulatory care visit within 90 days postdischarge. Mean time (SD) to first ambulatory care visit was 12.0 (26.0) and 16.3 (35.1) days in intervention and usual care arms, respectively, with the majority of visits in both study arms to primary care providers. The COMPASS intervention resulted in a 27% greater use of ambulatory care services within 1 year postdischarge, relative to usual care [HR = 1.27 (95% CI: 1.14-1.41)]. The use of transitional care billing codes was significantly greater in the intervention arm as compared with usual care [OR = 1.87 (95% CI: 1.54-2.27)].Discussion: The COMPASS intervention, which was aimed at improving stroke post-acute care, was associated with an increase in the use of ambulatory care services by stroke and transient ischemic attack patients discharged home and an increased use of transitional care billing codes by ambulatory providers.

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Integration in stroke services: the challenges for primary and community care services

Cited by 3 publications

References 13 publications

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

Quantifying the Impact of Acute Stroke System of Care Transfer Protocols on Patient Outcomes

Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

Post-acute Ambulatory Care Service Use Among Patients Discharged Home After Stroke or TIA

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