Stroke Self-Management: Effect on Function and Stroke Quality of Life

中风自我管理：对功能和中风生活质量的影响

• 批准号: 9077057
• 负责人: TERESA M. DAMUSH
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9077057
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age; Ambulatory Care; Behavior; Blood Vessels; Caregivers; Caring; Case Manager; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Coagulation Process; Data; Department of Defense; Development; Diabetes Mellitus; Disease; Elements; Evaluation; Event; Evidence based program; Family; Focus Groups; Future; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Home environment; Hypertension; Intervention; Ischemic Stroke; Joints; Learning; Manuals; Medical; Methods; Morbidity - disease rate; Neurologic; Outpatients; Participant; Patient Care; Patients; Performance; Pilot Projects; Population; Prevention; Process; Provider; Psychologist; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Reporting; Research; Residual state; Risk; Risk Factors; Risk Management; Role; Self Efficacy; Self Management; Services; Social Work; Social isolation; Stroke; Stroke Volume; Stroke prevention; Structure; Suggestion; Survivors; Taxes; Telephone; Testing; Transient Ischemic Attack; Universities; Variant; Veterans; Work; Writing; base; behavioral health; clinical care; coping; cost; design; disability; evidence base; group support; health related quality of life; improved; loss of function; medical specialties; mortality; patient home care; point of care; post stroke; post stroke depression; prevent; primary outcome; programs; randomized trial; secondary outcome; telehealth; tool; treatment as usual; trend; trial comparing

DESCRIPTION (provided by applicant): Anticipated Impacts on Participant's Healthcare: This planned evaluation of our stroke self- management program may improve the patient's healthcare by establishing an evidence-based program for which VA case managers may implement to improve patient self-management and the health-related quality of life of stroke survivors. This program will produce standardized manuals for case managers and stroke survivors that may be used in the field, in the patient medical care home and via telehealth. Project Background: Stroke is prevalent and associated with increased morbidity and mortality. Stroke is the leading cause of long-term disability in the US. Within the VA, approximately 60,000 patients had a primary outpatient encounter for stroke during fiscal year 2010 (FY10). Data from the Office of Quality and Performance (OQP) Stroke Special Study demonstrate that more than 5,000 veterans were admitted to a VA facility for acute ischemic stroke in FY07 and another 5000 veterans with a transient ischemic attack (TIA) or mini-stroke, were admitted in a VA facility or received care at an urgent clinic or emergency department in VA. The total VA cost of stroke treatment was almost $315 million in FY05, with a cost per patient of over $18,000. Stroke/TIA survivors are at elevated risk for future vascular events and yet, there are no systematic post stroke programs offered widely in VA designed to reduce this risk and increase stroke specific quality of life in veterans. We recently developed and pilot tested a stroke self-management program that adapted the Stanford Chronic Disease program for stroke. Project Objectives: The objectives of this project are to: 1. Conduct a randomized trial comparing stroke survivors randomly assigned to receive a stroke self-management program on patient functioning, stroke self-management, and stroke specific quality of life compared to stroke survivors assigned to usual care; and 2. Conduct a summative evaluation among VA clinical providers, patients with stroke and their caregivers to understand the barriers and facilitators of implementing the stroke self-management program. Project Methods: To accomplish these aims, we will employ mixed methods. For the first aim, we will conduct a randomized controlled trial comparing subjects randomly assigned to the stroke self-management intervention to subjects randomly assigned to usual care. Subjects from both groups will be assessed at baseline, 3, 6, and 12 months. The stroke self-management program will be delivered over 6 months (12 weeks biweekly sessions followed by 12 weeks of bimonthly telephone and group support sessions). Usual care participants will receive written stroke risk factor materials. Our primary outcomes will be stroke specific quality of life and our secondary outcomes will be stroke self-management, self-efficacy, functioning, and post stroke depression. For the second aim, we will hold focus groups with participants and their caregivers to best understand their barriers to participation and suggestions for future implementation.

描述（由申请人提供）： 对参与者医疗保健的预期影响：本卒中自我管理项目的计划评价可通过建立基于证据的项目来改善患者的医疗保健，VA病例经理可实施该项目，以改善患者的自我管理和卒中幸存者的健康相关生活质量。 该计划将为病例管理人员和中风幸存者制作标准化手册，这些手册可用于现场、患者医疗护理之家和远程医疗。 项目背景：卒中是一种常见病，并与发病率和死亡率的增加相关。 中风是老年人长期残疾的主要原因， 我们 在VA内，2010财年（FY 10）期间约有60，000例患者因卒中接受了初次门诊治疗。 来自质量和性能办公室（OQP）卒中特殊研究的数据表明，在2007财年，超过5000名退伍军人因急性缺血性卒中入住VA机构，另有5000名患有短暂性脑缺血发作（TIA）或轻微卒中的退伍军人入住VA机构或在VA的急诊室或急诊科接受护理。 在2005财年，中风治疗的VA总成本接近3.15亿美元，每位患者的成本超过18000美元。 卒中/TIA幸存者未来发生血管事件的风险升高，但是，在VA中没有广泛提供旨在降低这种风险并提高退伍军人卒中特异性生活质量的系统性卒中后计划。 我们最近开发了一个中风自我管理项目，并进行了试点测试，该项目改编自斯坦福大学的中风慢性病项目。 项目目标：本项目的目标是：1。进行一项随机试验，比较随机分配接受卒中自我管理计划的卒中幸存者与分配接受常规护理的卒中幸存者在患者功能、卒中自我管理和卒中特异性生活质量方面的差异;和2.在VA临床提供者、卒中患者及其照顾者中进行总结性评估，以了解实施卒中自我管理计划的障碍和促进因素。 项目方法：为了实现这些目标，我们将采用混合方法。 对于第一个目标，我们将进行一项随机对照试验，比较随机分配到卒中自我管理干预组和随机分配到常规护理组的受试者。 将在基线、3个月、6个月和12个月时对两组受试者进行评估。 中风自我管理计划将在6个月内实施（每两周进行一次课程，为期12周，然后每两个月进行一次电话和小组支持课程，为期12周）。 患者护理参与者将收到书面卒中风险因素材料。 我们的主要结果将是中风特定的生活质量和我们的 次要结果是卒中自我管理、自我效能、功能和卒中后抑郁。 至于第二个目标，我们将与参与者及其照顾者举行焦点小组会议，以最好地了解他们参与的障碍，并为未来的实施提出建议。