A Post Discharge Intervention to Improve Stroke Outcomes

出院后干预可改善中风结果

• 批准号: 6748928
• 负责人: KYLE RICHARD ALLEN
• 金额: $ 26.08万
• 依托单位: SUMMA HEALTH
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-06-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6748928
• 关键词: behavioral /social science research tag; caregivers; clinical research; comprehensive care; disease /disorder proneness /risk; functional ability; health care model; health care service evaluation; health services research tag; human subject; human therapy evaluation; interdisciplinary collaboration; medical complication; medical rehabilitation related tag; model design /development; neuromuscular function; patient care management; pharmacists; posthospitalization care; quality of life; rehabilitation; speech therapy; stroke; stroke therapy

A need exists for effective and cost-efficient approaches to the management of stroke survivors, not only to prevent recurrent stroke but also to prevent and manage other post-stroke complications. Currently, it is assumed that by the time of discharge from an acute care or rehabilitation setting the patient, family, primary care physician, physiatrist, and neurologist have negotiated a shared responsibility to assure compliance with prescribed treatments. Often, this assumption is not met, resulting in fragmented care and negative patient outcomes that could have been prevented. As has been shown to be effective for the management of other chronic diseases, effective post-discharge stroke care management must not only address the physical needs of the stroke survivor, but also psychosocial issues which are known to impact on stroke outcomes. Previous post-stroke care research has found little improvement in patient outcomes due, in part, to the lack of a truly comprehensive care model. Many studies have been narrowly focused on medical management of targeted stroke-related conditions, for example hypertension or diabetes, with little or no consideration of the effect of the interplay between psychosocial and other variables. Other studies focused more on psychosocial, rather than physical, interventions. No previous studies have measured the patient's global well being as a study outcome. We propose a randomized controlled trial of 380 post-discharge ischemic stroke patients. The primary aim of this study is to determine the effectiveness of an integrated post-discharge interdisciplinary stroke care model in improving stroke survivor's global well being (a composite of neuromotor function, severe complications, management of risk for common post-stroke complications, quality of life, and stroke knowledge) by six months as compared to stroke patients who receive usual post- discharge care. Our model, tested and refined in a pilot study at this community teaching hospital, overcomes many of the weaknesses of previous trials of post-stroke care management. The pilot results showed that this intervention had a significant positive overall impact on stroke survivors' well being. This study will advance the field's knowledge of the effectiveness of truly comprehensive post-discharge stroke care management. The standardized assessments and intervention protocols can be used as a template that is easily adapted to a variety of health care settings. Such information will allow more effective and efficient management of stroke survivors

需要有效和具有成本效益的方法来管理卒中幸存者，不仅要预防复发性卒中，还要预防和管理其他卒中后并发症。 目前，假设在从急性护理或康复环境中出院时，患者、家庭、初级保健医生、理疗师和神经科医生已经协商了共同的责任，以确保遵守规定的治疗。 通常，这一假设得不到满足，导致支离破碎的护理和本可以预防的负面患者结果。正如已被证明对其他慢性疾病的管理是有效的，有效的出院后卒中护理管理不仅必须解决卒中幸存者的身体需求，而且还必须解决已知会影响卒中结局的心理社会问题。 以前的中风后护理研究发现，患者的预后几乎没有改善，部分原因是缺乏真正全面的护理模式。 许多研究一直狭隘地集中在有针对性的中风相关疾病的医疗管理，如高血压或糖尿病，很少或根本没有考虑心理社会和其他变量之间的相互作用的影响。 其他研究更多地关注心理社会干预，而不是身体干预。 以前没有研究将患者的整体健康状况作为研究结果。我们提出了一个随机对照试验380出院后缺血性中风患者。 本研究的主要目的是确定与接受常规出院后护理的卒中患者相比，出院后综合跨学科卒中护理模式在改善卒中幸存者6个月的整体健康（神经运动功能、严重并发症、常见卒中后并发症风险管理、生活质量和卒中知识的复合指标）方面的有效性。我们的模型，在这个社区教学医院的试点研究中测试和完善，克服了许多中风后护理管理以前的试验的弱点。 试点结果表明，这种干预措施对中风幸存者的健康有显著的积极影响。 这项研究将促进该领域的知识的有效性，真正全面的出院后中风护理管理。 标准化的评估和干预方案可以作为一个模板，很容易适应各种医疗保健环境。这些信息将使中风幸存者的管理更加有效和高效

项目成果

The AD-LIFE trial: working to integrate medical and psychosocial care management models.

AD-LIFE 试验：致力于整合医疗和社会心理护理管理模式。

• DOI: 10.1097/01.nhh.0000269964.34045.d5
• 发表时间: 2007
• 期刊: Home healthcare nurse
• 作者: Wright,Kathy;Hazelett,Susan;Jarjoura,David;Allen,Kyle
• 通讯作者: Allen,Kyle

Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees.

在医疗保险 - 美食辅助人员中影响身体机能和情感福祉的因素。

• DOI: 10.1016/j.gerinurse.2015.02.022
• 发表时间: 2015-03
• 期刊: GERIATRIC NURSING
• 影响因子: 2.7
• 作者: Wright, Kathy D.;Pepper, Ginette A.;Caserta, Michael;Wong, Bob;Brunker, Cherie P.;Morris, Diana L.;Burant, Christopher J.;Hazelett, Susan;Kropp, Denise;Allen, Kyle R.
• 通讯作者: Allen, Kyle R.

A randomized trial testing the superiority of a postdischarge care management model for stroke survivors.

• DOI: 10.1016/j.jstrokecerebrovasdis.2009.02.002
• 发表时间: 2009-11
• 期刊: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
• 影响因子: 2.5
• 作者: Allen, Kyle;Hazelett, Susan;Jarjoura, David;Hua, Keding;Wright, Kathy;Weinhardt, Janice;Kropp, Denise
• 通讯作者: Kropp, Denise