Abstract TP376: Effect of Organized Stroke Education Program of Stroke Unit for Acute Stroke Patients to Increase Medication Compliance after Discharge

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hee Seon Yu ◽  
Hyeseon Jeong ◽  
Nayoung Yoon ◽  
Hee-Jung Song ◽  
Jei Kim
Keyword(s):  
Education Program ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Medication Compliance ◽  
Stroke Patients ◽  
Education Group ◽  
Stroke Education ◽  
Education Effects ◽  
Antithrombotic Medication

Background and purpose: Interdicipinary education program of stroke unit might be important to improve secondary prevention by increase of medication compliance and maintenance of relationship with physician. The present study evaluated that our education program of stroke unit including education materials for stroke prevention and man-to-man education schedule of stroke unit is helpful to increase the medication compliance and future follow-up rate for first-ever stroke patients. Methods: We first developed education materials, which were consisted of mechanisms and clinical characteristics of stroke, and importance of medication maintenance for secondary stroke prevention. Then man-to-man education was provided for patients who admitted stroke unit (Education group) from January to June of 2012. Medication maintenance rate at 3 months and follow-up rates checked 1 and 3 months after discharge were evaluated. Then, to evaluate the education effects, the rates of Education group were compared ones of No-Education group who were treated in general ward with no organized stroke education from January to June of 2010. Results: Total 392 patients (178; No-Education, 214; Education group) were enrolled. Among patients who admitted to stroke unit, 96.7% were educated by 2 stroke coordinators during admission period. The follow-up rates after discharge were slightly higher in Education group within 1month (89% vs 82%, p <0.05). Maintenance of the follow-up was significantly higher in Education group after 3months (83% vs 61%, p <0.05) than No-Education group. Maintenance rates of antithrombotic medication was highly achieved in the Education group (98% vs 89%, p <0.05) during follow-up period of 3 months. Conclusions: We observed that the educational effect of stroke unit is well maintained till 3 months after discharge. The high follow-up rate and good medication compliance could be obvious benefits of interdisciplinary working stroke unit.

Abstract NS5: Improvement of Follow-up Rate After Discharge of Acute Ischemic Stroke Patients by the Man-to-man Education for Stroke During Admission

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Hee Sun Yu ◽  
Na Young Yun ◽  
Jong Wook Shin ◽  
Hye Seon Jeong ◽  
Sangeun Yoo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Education Program ◽  
Drug Information ◽  
Warning Signs ◽  
Stroke Patients ◽  
Nutrition Behavior ◽  
Number Of Patients ◽  
Stroke Education

Background: We have executed a man-to-man stroke education program for acute ischemic stroke patients during admission since 2012. The contents of the man-to-man stroke education includes warning signs of stroke, guidance for prompt actions after symptom onset, drug information, and exercise and nutrition behavior after discharge. We evaluated whether the man-to-man education given during admission is effective to improve follow-up rates after discharge for acute ischemic stroke patients. Methods: We compared clinical data including modified Rankin Scale (mRS) at discharge and length of stay and follow-up data after discharge of 697 acute ischemic stroke patients (Male:Female=283:414, mean age±SD, 69.0±12.1 years) admitted in 2013, who received the man-to-man education during admission, with the data of 602 patients (M:F=254:348, 67.1±12.2 years) admitted in 2008, who did not receive the active education during admission. To evaluate follow-up rates, we first checked the follow-up status of all included patients within 1, 4, 8, 12, 16 months after discharge. Then, follow-up rates at each time point were calculated as the ratio of the number of patients followed at the point to the all patients discharged in 2008 or 2013. Differences of the follow-up rates between 2008 and 2013 were compared at individual follow-up time points using one-sided x2-test. Results: Even though the favorable outcome defined as 0-3 of mRS at discharge was similar between 2008 and 2013 (2008 vs. 2013, 88.3 vs. 87.4%, p=0.342), length of admission was significantly shorter in 2013 than 2008 (2008 vs. 2013, 10.2 vs. 6.6 days, p<0.001). On follow-up rates evaluations, follow-up at 1 month was significantly higher in 2013 (89.8%) than 2008 patients (83.7%) (p=0.001). The follow-up rates subsequently decreased at 4months (2008 vs. 2013, 77.3 vs. 81.5%, p=0.040), 8 months (70.1 vs. 74.3%, p=0.051), 12 months (63.1vs. 67.6%, p=0.052), and 16 months (57.6 vs. 63.0%, p=0.028). However, the follow-up rates of 2013 patients was consistently higher than 2008 ones. Conclusion: The present data suggested that active education program for acute ischemic stroke patients could improve to follow-up rates of the patients after discharge.

Abstract WP328: A Nurse-Led Initiative Improves Adherence Rates for Stroke Follow-up and Blood Pressure Management

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Darren T Larsen ◽  
Helmi L Lutsep
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Retention Rates ◽  
Matched Cohort ◽  
Stroke Patients ◽  
Stroke Risk Factor ◽  
Chi Square Analysis

Background and Issues Aggressive management of vascular risk factors reduces stroke rates. It is unknown whether structured nurse-led follow up increases adherence rates for stroke patients after hospital discharge. Purpose The purpose of this program is to improve secondary stroke risk factor management by instituting a nurse-led initiative called Stroke Therapy, Education, Prevention (STEP). Methods The pilot STEP program was based on protocols used for other stroke prevention trials. This nurse-led program includes inpatient initiation and outpatient maintenance of pharmacologic and lifestyle goals for stroke patients. Eligible patients have a non-disabling ischemic stroke or TIA and are without insurance restrictions and live within a distance allowing return to clinic for follow up. Prior to discharge, the STEP nurse completes patient education, and reviews outpatient goals. The STEP nurse makes phone contact with the patient 7-10 days after discharge to review medication compliance and reinforce education. At 30 days post discharge patients are seen in clinic by the STEP nurse where a resting blood pressure (BP) is measured. If the patient does not meet targets (<140 SBP or <130 SBP for DM) medications are adjusted by a stroke neurologist. We undertook a retrospective chart review of a consecutive cohort of patients matched to STEP eligibility criteria to determine whether the program improved retention rates and BP management. Chi-Square analysis was used to compare visit adherence and percentage achieving goal BPs at 30 days. Results In the STEP group 25/32(78%) patients completed the 30 day follow up compared to 14/32 (44%) patients in the historical matched cohort (p=0.0048). Target BP was achieved in 13/25(52%) STEP patients and 5/14 (36%) matched cohort patients (p=0.32) returning to clinic. Overall, target BP was achieved in 13/32 (41%) and 5/32 (16%) respectively (p=0.026). Conclusions In conclusion, follow up adherence and BP management in the group as a whole was better in the nurse-led model and is recommended for secondary stroke prevention. Long term follow up with this model may further increase in-target rates of BP control and other stroke risk factors.

Abstract T P305: Fragmented Care Among Stroke Patients at 4 Chicago Hospitals

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Carlos Corado ◽  
John Cashy ◽  
Abel Kho ◽  
Shyam Prabhakaran
Keyword(s):  
Acute Stroke ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Medication Compliance ◽  
Stroke Patients ◽  
Health Records ◽  
Longitudinal Tracking ◽  
A Site ◽  
Fragmentation Of Care

Background/Objective: Stroke patients may be unable to provide medical history. Given the urgency of decision-making in acute stroke and importance of medication compliance post-stroke, prompt access to prior health records could reduce delays and errors. We hypothesized that stroke patients often have fragmented care in the Chicago Health Atlas. Methods: The Chicago Health Atlas encompasses clinical data on over 1 million unique patients within the 606xx ZIP codes of Chicago. A unique ID is created for each patient through the use of a secure one-way hash function. The creation of a unique ID enables longitudinal tracking of a patient’s care across participating sites. We identified all acute stroke admissions to any of 4 Chicago Health Atlas hospitals using ICD-9 codes (430-436) and searched for prior inpatient or outpatient encounters at any of those sites. Fragmented care was defined as having prior encounters at a site different from the site of stroke hospitalization. In the same cohort, we assessed post-hospitalization outpatient encounters within the Health Atlas. Results: There were 5,980 stroke patients with emergency department or inpatient visits between 2006 and 2010. Of these, 3,732 (62.4%, mean age 61.1 years, 47% black) had non-fragmented care prior to stroke while 2,066 (34.5%, mean age 58.1 years, 31% black) were completely new encounters (first-ever) in the Health Atlas and only 182 (3.0%, mean age 57.5 years, 59% black) had fragmented care. The percent with fragmented care increased from 1.3% in 2006 to 3.3% in 2010 (p<0.001 for trend). Rates of follow-up within following 12 months varied across the 3 groups (non-fragmented: 75% and fragmented: 64% vs. new: 51.4%; p<0.001). Conclusions: Two-thirds of stroke patients have previously accessed the health care system, with a majority having records at the same site of stroke hospitalization. However, 3% of patients have fragmented care, a rate that is increasing over time. Our estimate of fragmentation may be an underestimate since only 4 sites were included in this analysis. Having health information exchange may be valuable in reducing fragmentation of care for stroke patients.

Abstract T MP79: Correlation Between ST Segment Abnormalities at Admission and Worse Neurologic Outcome 90 Days After Stroke: a Prospective Trial

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Gabriel P Braga ◽  
Renato S Gonçalves ◽  
Luiz Eduardo G Betting ◽  
Marcos F Minicucci ◽  
Rodrigo Bazan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Prospective Trial ◽  
Neurologic Outcome ◽  
Clinical Aspects ◽  
Cardiac Complications ◽  
Stroke Patients ◽  
St Segment ◽  
Increased Risk

Introduction: Cerebrovascular diseases are important causes of disability and death. Cardiovascular diseases and stroke share most of the risk factors and there is an intense relation between cerebral and cardiac homeostasis. Electrocardiogram can be used as measurement of neurogenic cardiac abnormalities as it has been suggested that lesions in the insula may result in abnormal electrocardiographic (ECG) findings and increased risk of sudden death. We assessed the hypothesis that electrocardiographic changes in acute stroke could predict neurological outcome at 90 days Methods: It was a longitudinal prospective study, with stroke patients admitted in an acute Stroke Unit from March 2012 to March 2013. We included all stroke patients within 24h of symptom onset and diagnosis confirmed with head CT scans. We excluded patients with history of cardiac surgery, myocardial infarct and pulmonary thromboembolism within 2 weeks before stroke. We collect data about clinical history and demography, admission NIHSS score and ECG. All patients were followed and in hospital complications, length of stay and modified Rankin score at 90 days were registered. Follow up visits were done by a Neurologist blinded to admission ECG findings; and ECG were analyzed by a Cardiologist blinded to clinical aspects. Statistical analysis was done with logistic regression with correction to gender, admission NIHSS, presence of clinical complications and blood pressure control. Results: Of 247 admitted to stroke unit, 112 fulfilled inclusion criteria and agreed to participate. It was observed positive correlation between ST segment abnormalities on admission ECG and cardiac complications during hospitalization (OR 4.73, IC(95%) 1.49 - 14.98, p: 0.008), worse neurologic outcome at 90 days measured by Rankin 3 - 6 (OR 3.4, IC(95%) 1.07-11.12, p: 0.038), and death at the end of follow up (OR 4.25, IC(95%) 1.17-15.49, p: 0.028). Conclusions: In conclusion, this study showed that ECG findings at admission, especially ST segment abnormalities, were correlated to higher chance of in hospital cardiac complications, worse neurologic outcomes and mortality at 90 days.

Abstract W P287: Collaborative Cryptogenic Stroke Clinic Improves Secondary Stroke Prevention While Helping Achieve Stroke Metrics

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mark Richards ◽  
Kelley joseph ◽  
James Auberle ◽  
Syed Zaidi ◽  
Mohommad Jumaa
Keyword(s):  
Medication Compliance ◽  
Cryptogenic Stroke ◽  
Stroke Recovery ◽  
Team Approach ◽  
Stroke Patients ◽  
Readmission Rates ◽  
Stroke Outcomes ◽  
Real Risk ◽  
Multiple Stroke

Introduction: Stroke centers are faced with the challenges of achieving stroke metrics to meet certification requirements. Recent trials have demonstrated the efficacy of the implantable cardiac monitor (ICM) in detecting atrial fibrillation (AF) in cryptogenic stroke patients. We have created a Comprehensive Cryptogenic Stroke Clinic (CCSC), a collaborative effort between electrophysiology (EP) and stroke neurology, which improves patient care and provides a venue for successfully addressing stroke metrics. Methods: All acute ischemic stroke patients (n= 2100) in the ProMedica Stroke Network were screened and evaluated by an EP and vascular stroke neurologist. Appropriate cryptogenic patients are offered an ICM for AF detection, ideally during their stroke admission. Patients are evaluated periodically, both for their rhythm status and their stroke recovery, and important stroke metric follow-up data such as medication compliance, obtaining Modified Rankin scores at 90 days and prevention of stroke readmission through availability of resources. Results: We have enrolled 135 patients in our CCS clinic and implanted 92 loop monitors for AF detection. Through follow-up in CCSC, we have: detected AF in 11 patients; identified 27 patients with additional therapy needs; and modified medical management for 38 patients to decrease their secondary stroke risk. 90-day Modified Rankin score compliance improved from 27% to 67%. The collaboration and efficiency has improved stroke outcomes and helped reduce readmission rates by 22% since the CCSC’s inception. Conclusions: Our CCSC has improved compliance with multiple stroke metrics, while ensuring patients are cognizant of their real risk for another stroke. Our collaborative team approach has been instrumental in reducing stroke readmission rates, changing medical therapies, and offering additional resources are streamlined through medical collaboration. The CCSC has proven to be a critical venue for accomplishing successful stroke outcomes.

scholarly journals Early home-supported discharge for patients with stroke in Portugal: a randomised controlled trial

2016 ◽  
Vol 31 (2) ◽  
pp. 197-206 ◽  
Author(s):  
Silvina Santana ◽  
José Rente ◽  
Conceição Neves ◽  
Patrícia Redondo ◽  
Nina Szczygiel ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Controlled Trial ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Stroke Patients ◽  
Control Groups ◽  
Open Label

Objective: To evaluate an early home-supported discharge service for stroke patients. Design: We carried out a prospective, randomised, open-label, blinded-endpoint trial (allocation ratio of 1:1) with patients assigned to either an early home-supported discharge service or usual care. Setting: The study was undertaken in Aveiro, Portugal, between April 2009 and April 2013. Subjects: We included stroke patients aged 25–85 years admitted to the stroke unit with an initial Functional Independence Measure of up to 100, who gave informed consent. Interventions: Patients in the early home-supported discharge group began their rehabilitation intervention in the stroke unit and the early home-supported discharge team worked with them at home for a maximum of one month. Patients in the control group received usual services. Main measures: The primary outcome measure was the Functional Independence Measure at six months after stroke. Results: We randomised 190 patients of whom 34 were lost to follow-up. There were no significant differences (p > 0.5) in the average scores of Functional Independence Measure between the early home-supported discharge (69 ±22; mean ±SD) and the control groups (71 ±17) measured at baseline; and between the early home-supported discharge (107 ±20) and the control groups (107 ±25) measured at six months. The number of individuals with a low Functional Independence Measure score (<60) in the early home-supported discharge group compared with the control group was higher at admission (34/95 vs. 26/95) and lower at follow-up (2/74 vs. 5/78). Conclusions: It was feasible to implement early home-supported discharge procedures in a Southern European setting, but we have not shown convincing differences in disability at six months.

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