Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke

Age Ageing. 2008 Jan;37(1):32-8. doi: 10.1093/ageing/afm133. Epub 2007 Nov 14.

Abstract

Objectives: to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager would experience, compared to usual post-hospital care, better health-related quality of life (HRQL), fewer emergency room visits and less non-elective hospitalisations.

Design: a stratified, balanced, evaluator-blinded, randomised clinical trial.

Setting: five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.

Participants: persons (n = 190) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function, co-morbidity, or isolation.

Intervention: for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls designed to coordinate care with the person's personal physician and link the stroke survivor into community-based stroke services.

Measurements: the primary outcome was the Physical Component Summary (PCS) of the Short-Form (SF)-36 survey. A secondary outcome was utilisation of health services. Also measured was the impact of stroke on functioning. Measurements were made at hospital discharge (baseline), following the 6-week intervention and at 6-months post-stroke.

Results: the average age of the participants was 70 years. Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity. There were no differences between groups on the primary outcome measure, health services utilisation, or any of the secondary outcome measures.

Conclusion: for this population, there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact, than usual post-discharge management.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aftercare
  • Aged
  • Aged, 80 and over
  • Case Management* / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Family Practice*
  • Female
  • Follow-Up Studies
  • House Calls / statistics & numerical data
  • Humans
  • Interprofessional Relations*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Care Team* / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Quality of Life / psychology
  • Quebec
  • Secondary Prevention
  • Single-Blind Method
  • Stroke / mortality
  • Stroke / psychology
  • Stroke / therapy*
  • Survival Rate
  • Utilization Review / statistics & numerical data