Michigan Stroke Transitions Trial

Abstract

Background: To test whether access to home-based social worker–led case management (SWCM) program or SWCM program combined with a website providing stroke-related information improves patient-reported outcomes in patients with stroke, relative to usual care. Methods and Results: The MISTT (Michigan Stroke Transitions Trial), an open (unblinded) 3-group parallel-design clinical trial, randomized 265 acute patients with stroke to 3 treatment groups: Usual Care (group-1), SWCM (group-2), and SWCM+MISTT website (group-3). Patients were discharged directly home or returned home within 4 weeks of discharge to a rehabilitation facility. The SWCM program provided in-home and phone-based case management services. The website provided patient-orientated information covering stroke education, prevention, recovery, and community resources. Both interventions were provided for up to 90 days. Outcomes data were collected by telephone at 7 and 90 days. Primary patient-reported outcomes included Patient-Reported Outcomes Measurement Information System Global-10 Quality-of-Life (Physical and Mental Health subscales) and the Patient Activation Measure. Treatment efficacy was determined by comparing the change in mean response (90 days minus 7 days) between the 3 treatment groups using a group-by-time interaction. Subjects were aged 66 years on average, 49% were female, 21% nonwhite, and 86% had ischemic stroke. There were statistically significant changes in Patient-Reported Outcomes Measurement Information System Physical Health ( P =0.003) and Patient Activation Measure ( P =0.042), but not Patient-Reported Outcomes Measurement Information System Mental Health ( P =0.56). The mean change in Patient-Reported Outcomes Measurement Information System Physical Health scores for group-3 (SWCM+MISTT Website) was significantly higher than both group-2 (SWCM; difference, +2.4; 95% CI, 0.46–4.34; P =0.02) and group-1 (usual care; difference, +3.4; 95% CI, 1.41–5.33; P <0.001). The mean change in Patient Activation Measure scores for group-3 was significantly higher than group-2 (+6.7; 95% CI, 1.26–12.08; P =0.02) and marginally higher than group-1 (+5.0; 95% CI, −0.47 to 10.52; P =0.07). Conclusions: An intervention that combined SWCM with access to online stroke-related information produced greater gains in patient-reported physical health and activation compared with usual care or case management alone. There was no intervention effect on mental health. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02653170.

Enablers and barriers in hospital‐to‐home transitional care for stroke survivors and caregivers: A systematic review

“…The overall burden of stroke is considerable and continues to increase in the context of an ageing population (GBD, 2016Stroke Collaborators, 2019. Most stroke survivors are discharged to home, and the hospital-to-home transition poses many challenges for them and family caregivers to manage care at home whilst engaging in rehabilitation and recovery (Lindblom et al, 2020;Reeves et al, 2019). These challenges have become more prominent in the context of shortened hospital stays and early discharge by which stroke patients and their caregivers take charge of care activities and coordinate care services instead of health professionals in hospital (Camicia et al, 2016;Chen et al, 2020).…”

“…Most stroke survivors live with declined functioning such as poor balance, incontinence, swallowing difficulties, visual disturbances and psychological and cognitive disorders (Jokinen et al, 2015;Wainwright et al, 2017). Hospital readmissions are common after discharge and are associated with increased morbidity, mortality and risk of early institutionalisation (Abreu et al, 2020;Reeves et al, 2019). Contributing factors to readmissions include falls, urinary tract infection and recurrence of stroke (Abreu et al, 2020;Kilkenny et al, 2020).…”

Development of an informational support questionnaire of transitional care for aged patients with chronic disease

“…[14][15][16] These patients, who are repeatedly transferred from hospitals to their homes often do not get high-quality information support; resulting Open access in a poor quality of continuing care, especially in medication information and discharge plan implementation. [17][18][19][20] Therefore, for this special vulnerable group, we need to ensure high-intensity information support in carrying out their transitional care. 21 22 This is cost-effective for the country, both in terms of economy and social benefits.…”

Illness beliefs and emotional responses in mildly disabled stroke survivors: A qualitative study

“…Perceived treatment control is a predictor of higher medication adherence in other conditions [19], this dimension should be addressed in specific educational programs providing information and support in behavior change particularly for persons who do not have access to rehabilitation services. In this way, several studies showed the effectiveness of community stroke educational groups [35,36]. Combining several media of information and educational support could improve survivors capability to use the information provided, as in nurse-led education programs [37], websites designed for this aim [36,38], case management [36], and peer-support groups [39].…”