Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: a randomized trial.
Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: a randomized trial.
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DOI：
10.1053/jscd.2002.127106
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发表时间：
2002-03-01
期刊：
影响因子：
--
通讯作者：
Wright, K
中科院分区：
文献类型：
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作者：
Allen, Kyle R;Hazelett, Susan;Wright, K
背景技术背景：本随机对照试验测试了全面的，跨学科的出院后护理管理的有效性，在改善中风和短暂性脑缺血发作（TIA）patients.METHODS：96中风/TIA患者的健康恢复和二级预防（健康和预防配置文件）的指标的配置文件被随机分配到常规护理或干预在我们的急性中风单位出院。干预组在1个月时接受由高级实践护士进行的家庭生物心理社会评估。一个跨学科的团队制定了护理计划，并与患者的初级保健医生合作实施。在3个月时测量的健康和预防概况包括5个领域：（1）神经运动功能，（2）严重并发症，（3）生活质量，（4）常见卒中后并发症和复发性卒中的风险管理，以及（5）卒中知识。一个单一的全球假设检验在多个终点被用来比较2 groups.Results：干预显着改善健康和预防的形象（P <0.0001）。此外，每个领域都显示出干预的积极效果。效应量（以标准差为单位）的干预领域为.1神经运动功能（90%置信区间[CI] =-0.3至0.5）;严重并发症为0.4（90% CI = .1至.8）;生活质量为.5（90% CI = .1至.9）;常见卒中后并发症和复发性卒中的风险管理为.6（90% CI = .3至1）;脑卒中知识为1.0（90%CI = 0.6 - 1.4）。结论：这种护理管理模式使出院后3个月的脑卒中/TIA患者的健康和预防状况明显改善。
BACKGROUND: This randomized controlled trial tested the effectiveness of comprehensive, interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention (profile of health and prevention) in stroke and transient ischemic attack (TIA) patients.METHODS: Ninety-six stroke/TIA patients were randomized to usual care or intervention at discharge from our acute stroke unit. The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month. A care plan was developed by an interdisciplinary team and implemented in collaboration with the patient's primary care physician. The profile of health and prevention, measured at 3 months, was comprised of 5 domains: (1) Neuromotor Function, (2) Severe Complications, (3) Quality of Life, (4) Management of Risk for common poststroke complications and recurrent stroke, and (5) Stroke Knowledge. A single global hypothesis test across multiple end points was used to compare the 2 groups.RESULTS: The intervention significantly improved the profile of health and prevention (P < .0001). In addition, each domain showed a positive effect of the intervention. Effect sizes (in standard deviation units) of the intervention on domains were .1 for Neuromotor Function (90% confidence interval [CI] = -.3 to .5); .4 for Severe Complications (90% CI = .1 to .8); .5 for Quality of Life (90% CI = .1 to .9); .6 for Management of Risk for common poststroke complications and recurrent stroke (90% CI = .3 to 1.); and 1.0 for Stroke Knowledge (90% CI = .6 to 1.4).CONCLUSIONS: This model of care management resulted in a significantly better profile of health and prevention for stroke/TIA patients 3 months postdischarge.