MATCHING NEEDS OF STROKE PATIENTS WITH CAREGIVING RESOURCES TO IMPROVE OUTCOMES

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DESCRIPTION (provided by applicant): Stroke is an unpredictable, life-disrupting event allowing patients and families little time to prepare for its consequences. Family members are often expected, but unprepared, to take on caregiving tasks for stroke patients after discharge from inpatient rehabilitation facilities (IRFs) resulting in patient safety issues, caregiver burden, depression, and reduced quality of life. Successful post-discharge outcomes are related to the match between available caregiving resources and the patient's need for care. The long-term goal of this research program is to develop primary prevention strategies to facilitate this match prior to discharge from an IRF. A critical preliminary step requires exploring how patients and families perceive their caregiving resource needs, and to compare these with the perspectives of nurse case managers who assist them with discharge planning. Using grounded theory, the proposed study will address the following specific aims: 1) to develop a conceptual framework illustrating the influence of the match between resources and need as it relates to discharge destination for stroke patients being discharged from an IRF; and 2) to design and pilot a research-based, decision-making matrix (algorithm) for assessing and matching caregiving resources to the needs of stroke patients and their families at two IRFs. Twenty patient/family units, which will include the stroke patient, their primary informal caregivers, and other key family members, will be recruited from two IRFs. Members of these patient/family units will be interviewed during the patient's stay on the IRF and within 6 months post-discharge. Open-ended, loosely structured interview questions will encourage study participants to describe how decisions about discharge destination were made, and how caregiving resources were identified. A decision- making algorithm will be developed based on the findings from these interviews. Two nurse case managers at each of the participating sites will pilot the algorithm with three patients each. After piloting the algorithm, these nurse case managers will be interviewed to determine the applicability and usefulness of the algorithm in practice. Findings from this study will a) clarify the dimensions related to how discharge decisions are made and how mismatches between patient needs and caregiving resources occur, and b) guide the development of a decision-making matrix (algorithm) for nurse case managers to use when assisting patients and their families through the discharge decision-making process. This proposal addresses the following NINR areas of emphasis for R-15 applications: quality of care and chronic illness experiences, and their influence on quality of life for patients, families, and caregivers.