Bridging the Gap: Meeting the discharge needs of stroke patient/caregiver dyads

描述（由申请人提供）：中风是美国残疾的主要原因，超过450万中风幸存者生活在社区，功能受限，需要家庭护理人员的帮助。中风突然发生，是不可预测的，扰乱生活，不允许患者和家庭有足够的时间为众多的中风后康复需求做准备。中风患者通常从住院康复中的多个提供者的照顾过渡到依赖一个人（通常是配偶照顾者），这个人没有准备好处理家中充分护理所需的压倒性需求和持续警惕。配偶照顾者比其他家庭成员更有可能受到离婚的不良影响。他们描述的是被孤立、被遗弃和孤独的感觉，随之而来的往往是可预测的抑郁轨迹和身体健康状况恶化的螺旋式下降。研究未能解决危机驱动的方法，以决定有关的资源和出院目的地，最终在病人的需求和配偶照顾者的能力，以提供出院后护理之间的严重不匹配。需要卒中出院干预模型来充分预测和解决与卒中患者及其护理人员相关的出院后问题。这些模式应基于对患者需求和护理人员能力之间匹配的全面评估，并在康复出院前实施。这种中风二分体的联合评估是干预模型开发和测试的必要前提。来自几个国家的卒中护理临床实践指南已经确定了在住院康复轨迹早期对患者和护理人员进行评估的重要性，以确定患者需求和护理人员的关注点和能力，但是，尚未开发任何工具来填补这一空白。本混合方法研究的目的是开发和试点一个全面的二元风险评估概况，以评估患者的需求和护理人员的关注和能力，并确定在临床环境中实施该风险评估的可行性。实施风险评估档案是开发卒中出院干预模型的关键第一步，有助于患者、配偶照顾者和康复团队成员更好地了解从住院康复过渡回家时的需求。 公共卫生相关性：这项研究计划的长期目标是开发一种卒中后出院计划干预措施，以改善卒中幸存者和配偶照顾者的健康和生活。本研究中试行的二元风险评估概况是该计划的第一步，并将用于未来的研究，为中风患者及其配偶护理人员从住院康复中过渡回家时制定基于研究的干预措施提供信息。这项建议涉及国家自然资源研究所战略计划中与提高生活质量和生活质量有关的重点领域。

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability in the U.S. More than 4.5 million stroke survivors live in the community with functional limitations requiring the assistance of family caregivers. Stroke occurs suddenly, is unpredictable, life-disrupting, and does not allow patients and families sufficient time to prepare for the numerous post-stroke caregiving needs. Stroke patients typically transition from being cared for by multiple providers in inpatient rehabilitation to relying on one person (most often a spousal caregiver) who is unprepared to handle the overwhelming demands and constant vigilance required for adequate care at home. Spousal caregivers are more likely to suffer from the ill-effects of caregiving than other family members. They describe feeling isolated, abandoned, and alone, and what frequently follows is a predictable trajectory of depression and a downward spiral of deteriorating physical health. Research has failed to address the crisis-driven approach to decisions about caregiving resources and discharge destination, culminating in serious mismatches between patient needs and spousal caregiver capacity to provide post-discharge care. Stroke discharge intervention models are needed to adequately anticipate and address post-discharge concerns related to stroke patients and their caregivers. These models should be based on a comprehensive assessment of the match between patient need and caregiver capacity and implemented prior to discharge from rehabilitation. This combined assessment of the stroke dyad is a necessary antecedent to intervention model development and testing. Stroke care clinical practice guidelines from several countries have identified the importance of conducting assessments of patients and caregivers early in the inpatient rehabilitation trajectory to determine patient needs and caregiver concerns and capacity however, no tools have been developed to fill this gap. The purpose of this mixed methods study is to develop and pilot a comprehensive dyad risk assessment profile for evaluating patient needs and caregiver concerns and capacity, and to determine the feasibility of implementing this risk assessment in a clinical setting. Implementing a risk assessment profile is the critical first step in developing stroke discharge intervention models and helping patients, spousal caregivers, and members of the rehabilitation team acquire a better understanding of the dyads' needs as they transition home from inpatient rehabilitation. PUBLIC HEALTH RELEVANCE: The long-term objective of this program of research is to develop a post-stroke discharge planning intervention that improves the health and lives of stroke survivors and spousal caregivers. The dyad risk assessment profile that is piloted in this study is the first step in this program and will be used in a future study to inform the development of a research-based intervention for stroke patients and their spousal caregivers as they transition home from inpatient rehabilitation. This proposal addresses the NINR strategic plan areas of emphasis related to improving quality of life and caregiving.