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

描述(由申请人提供)： 对参与者医疗保健的预期影响：这项对我们的中风自我管理计划的计划评估可能会通过建立一个循证计划来改善患者的医疗保健，退伍军人管理局病例经理可以实施该计划来改善患者的自我管理和中风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，可在现场、患者医疗护理之家和远程保健中使用。项目背景：中风很普遍，并与发病率和死亡率的增加有关。中风是导致老年人长期残疾的主要原因 我们。在退伍军人事务部内，2010财年(2010财年)约有60,000名患者因中风而首次门诊就诊。质量与绩效办公室(OQP)中风特别研究的数据显示，2007财年，超过5,000名退伍军人因急性缺血性中风入院退伍军人管理局，另有5,000名患有短暂性脑缺血发作(TIA)或微小中风的退伍军人入院退伍军人管理局，或在退伍军人管理局的紧急诊所或急诊科接受治疗。2005财年，中风治疗的退伍军人管理局总成本近3.15亿美元，每个患者的成本超过1.8万美元。中风/短暂性脑缺血发作的幸存者未来发生血管事件的风险较高，然而，退伍军人中还没有广泛提供的系统的中风后计划来降低这种风险并提高中风特定的生活质量。我们最近开发并试点测试了一项中风自我管理计划，该计划采用了斯坦福慢性病计划来治疗中风。项目目标：本项目的目标是：1.进行一项随机试验，比较随机分配到接受卒中自我管理计划的卒中幸存者和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定生活质量方面的差异；2.在VA临床提供者、卒中患者及其照顾者中进行终结性评估，以了解实施卒中自我管理计划的障碍和促进者。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的受试者和随机分配到常规护理组的受试者。两组受试者将在基线、3个月、6个月和12个月进行评估。中风自我管理计划将在6个月内实施(12周双周会议，然后12周双月电话和小组支持会议)。常规护理参与者将收到书面的中风风险因素材料。我们的主要结果将是特定于中风的生活质量，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。对于第二个目标，我们将与参与者及其照顾者举行焦点小组，以最好地了解他们参与的障碍和对未来实施的建议。

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.