Disparities in Transition of Care after Acute Stroke Hospitalization: The Transition of Care Stroke Disparity Study (TCSD-S)

急性中风住院后护理转变的差异：中风护理转变差异研究 (TCSD-S)

• 批准号: 10196956
• 负责人: JOSE G ROMANO
• 金额: $ 69.22万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-26 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10196956
• 关键词: Acute; Address; Adherence; Affect; Age; American; American Stroke Association; Cardiovascular system; Caring; Cause of Death; Cessation of life; Communities; Complex; Data; Data Collection; Disadvantaged; Drops; Enrollment; Environmental Risk Factor; Event; Family; Florida; Future; Guidelines; Health; Health Care Costs; Health Personnel; Health system; Healthcare Systems; Heart; Heart Diseases; Heart failure; Hispanics; Home; Hospital Mortality; Hospitalization; Hospitals; Individual; Infrastructure; Intervention; Lead; Life Style; Life Style Modification; Measures; Medical; Minority; Minority Groups; Modeling; Morbidity - disease rate; Myocardial Infarction; Outcome; Outpatients; Patient Education; Patients; Performance; Pharmaceutical Preparations; Prevalence; Preventive; Process; Public Health; Quality of life; Race; Records; Recovery; Recurrence; Registries; Rehabilitation therapy; Reporting; Resources; Stroke; Stroke prevention; Structure; Survivors; System; Telephone Interviews; Training Activity; Vulnerable Populations; Woman; acute stroke; aging population; base; care outcomes; care systems; cost; dashboard; disability; disparity reduction; ethnic disparity; follow-up; health care disparity; healthy lifestyle; hospital performance; hospital readmission; improved; improved outcome; indexing; instrument; medication compliance; mortality; multimodality; novel; post stroke; pressure; prevent; primary outcome; programs; readmission rates; rehabilitation service; sex disparity; social; social health determinants; socioeconomics; stroke outcome; stroke patient; stroke rehabilitation; stroke risk

Stroke, together with heart disease, accounts for the largest proportion of non-communicable diseases and deaths worldwide. In the US, there are 795,000 annual stroke cases and 150,000 deaths from stroke. Numbers will steeply increase with the aging population. Stroke remains the main cause of serious long-term disability with minorities being affected disproportionally. Greater risk of stroke exists among blacks and Hispanics at younger ages; blacks have greater stroke mortality. Though measures of quality of stroke care during acute hospitalization have improved, little evidence exists on the quality of processes leading to effective stroke prevention and rehabilitation after hospital discharge. Unexpected hospital readmissions 30 days after acute stroke hospitalization are common, as high as 25%, and lead to excess morbidity and cost. Stroke impact on patients', families', and communities' quality of life, and the burden on use and cost of health care is enormous. We propose the Transitions of Care Stroke Disparity Study (TCSD-S) with the main objective to identify race- ethnic and sex disparities in hospital-to-home transition of stroke care and outcomes, social determinants of health associated with these disparities, and to develop effective hospital-initiated system level initiatives to reduce disparities and readmissions, and to improve stroke outcomes. To achieve this objective, we will capitalize on the rich infrastructure and resources of our unique Florida Stroke Registry (FSR), which includes a well-developed network of hospitals, health providers, partnership with the AHA, and other Florida stakeholders. We will evaluate medication adherence, healthy lifestyle, utilization of rehabilitation interventions and medical follow-up 30 days after hospital discharge to home across representative Florida Comprehensive Stroke Centers. A novel Transitions of Stroke Care Performance Index (TOSC PI) will be derived and validated. Thi index will be a primary outcome together with hospital readmissions and stroke outcomes (disability, recurrence, cardiovascular events, and death). Data on TOSC and stroke outcomes will be collected by structured telephone interviews at 30 and 90 days after discharge and review of patient charts. Predictors of TOSC disparities and outcomes will be evaluated using baseline in-hospital data of the index stroke obtained from the FSR, and Social Determinants of Health obtained through a novel data collection instrument from publicly available records. Based on identified predictors of TOSC disparities, we will develop and assess the feasibility of initiatives to reduce TOSC disparities, targeting systems of care with a TOSC disparities dashboard, and health care providers with a training module for enhanced patient education and support at discharge and during follow-up. We will compare the TOSC PI and outcomes before and after the initiatives. The successful completion of this study will identify disparities in hospital-to-home TOSC, define key predictors of poor TOSC and stroke outcomes, and develop initiatives which will be scalable across health systems and which will address disparities, readmission rates, and poor outcomes.

中风与心脏病一起，在非传染性疾病中所占比例最大， 全世界的死亡人数。在美国，每年有 795,000 例中风病例，150,000 人死于中风。数字 将随着人口老龄化而急剧增加。中风仍然是严重长期残疾的主要原因 少数群体受到的影响尤为严重。黑人和西班牙裔中风的风险更大 年龄较小；黑人的中风死亡率更高。尽管急性期中风护理质量的衡量标准 住院率有所改善，但很少有证据表明导致有效中风的过程质量 出院后的预防和康复。急性发作后 30 天意外再次入院 中风住院很常见，高达 25%，并导致过高的发病率和费用。中风影响 患者、家庭和社区的生活质量以及医疗保健的使用和费用负担是巨大的。 我们提出护理中风差异研究的转变（TCSD-S），其主要目标是确定种族- 中风护理和结果从医院到家庭过渡的种族和性别差异，中风的社会决定因素 与这些差异相关的健康状况，并制定有效的医院发起的系统级举措，以 减少差异和再入院，并改善卒中结果。为了实现这一目标，我们将 利用我们独特的佛罗里达州卒中登记处 (FSR) 丰富的基础设施和资源，其中包括 完善的医院网络、医疗服务提供者、与 AHA 和其他佛罗里达州利益相关者的合作伙伴关系。 我们将评估药物依从性、健康的生活方式、康复干预措施和医疗的利用 出院后 30 天在佛罗里达州代表性综合中风中心进行随访回家。 将得出并验证一种新颖的中风护理绩效指数转变（TOSC PI）。该指数将是 主要结局以及再入院和中风结局（残疾、复发、 心血管事件和死亡）。 TOSC 和中风结果的数据将通过结构化电话收集 出院后 30 和 90 天的访谈以及患者病历的审查。 TOSC 差异的预测因子和 将使用从 FSR 获得的索引中风的基线院内数据和社会数据来评估结果 通过新型数据收集工具从公开记录中获得健康的决定因素。 根据已确定的 TOSC 差异预测因素，我们将制定并评估以下举措的可行性： 减少 TOSC 差异，通过 TOSC 差异仪表板瞄准护理系统和医疗保健 提供培训模块，以加强患者出院时和随访期间的教育和支持。 我们将比较举措前后的 TOSC PI 和结果。 这项研究的成功完成将确定医院与家庭 TOSC 的差异，确定关键预测因素 不良 TOSC 和中风结果，并制定可在整个卫生系统和 这将解决差异、再入院率和不良结果的问题。

项目成果

Ten-Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry.

• DOI: 10.1161/jaha.123.030272
• 发表时间: 2023-11-20
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4

Adherence to Acute Care Measures Affects Mortality in Patients with Ischemic Stroke: The Florida Stroke Registry.

• DOI: 10.1016/j.jstrokecerebrovasdis.2020.105586
• 发表时间: 2021-03
• 期刊: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
• 作者: Gardener H;Rundek T;Lichtman J;Leifheit E;Wang K;Asdaghi N;Romano JG;Sacco RL
• 通讯作者: Sacco RL

Disparities and Temporal Trends in Stroke Care Outcomes in Patients with Atrial Fibrillation: The FLiPER-AF Stroke Study.

房颤患者中风护理结果的差异和时间趋势：FLiPER-AF 中风研究。

• DOI: 10.29011/2688-8734.100017
• 发表时间: 2019
• 期刊: International journal of cerebrovascular disease and stroke
• 作者: Dong,Chuanhui;Wang,Kefeng;DiTullio,MarcoR;Gutierrez,Carolina;Koch,Sebastian;García,EnidJ;Zevallos,JuanCarlos;Nobo,Ulises;Martin,RyanC;Burgin,WScott;Rose,DavidZ;Romano,JoseG;Goldberger,JeffreyJ;Sacco,RalphL;Rundek,Tat
• 通讯作者: Rundek,Tat