Abstract P313: Feasibility of Nurse-Driven Identification of Depression in the Setting of Stroke at 30 Days Post Discharge

Background: Poststroke depression (PSD) is under-recognized and affects the recovery and rehabilitation of stroke patients. PSD affects one-third of stroke survivors and there is little known when depressive symptoms manifest. Early identification of PSD may reduce its related functional impairment and mortality. Purpose: The purpose of this study is to demonstrate the feasibility of nursing driven depression identification at 30-45 days post discharge. Methods: All primary stroke patients received a phone call from SCRN to assess depression between 30 to 45 days post discharge using the Patient Health Questionnaire (PHQ9). Three attempts were made per patient. Data were analyzed from August 2019 thru March 2020. Based on the PHQ9 scores, patients were referred to different clinical care pathways. Patients who scored 1-9 received lifestyle modification information, 10-19 were referred to depression care management (DCM), 20 and above were referred to psychiatry. The number of patients evaluated and the percentage of those who were referred to specific pathways were assessed. Results: 427 patients were discharged with a stroke diagnosis. 197 (46.1%) completed the PHQ9 assessment. 14 (7%) were ages 18 to 44 years, 65 (33%) were 45 to 64 years, and 118 (60%) were 65 years and above. 92 (47%) were female. 64% were Caucasian, 19% Asian, 13% Black, and 5% Other. 30% were Hispanic. 72% were ischemic, 19% ICH, and 9% SAH. 230 patients (53.9%) were not able to complete PHQ9. 88 (38%) were unavailable, and 120 patients (52%) were not able to participate due to stroke severity. 20 (10%) were referred to DCM and/or psychiatry. Conclusions: Nurse-driven 30-day PHQ9 assessment is feasible and identifies patients with depressive symptoms. The 30-45-day post-stroke timeframe may be reasonable to diagnose depression after an acute stroke.

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Potentially Preventable Hospital Readmissions After Patients’ First Stroke—A National Population-Based Study In Taiwan

10.21203/rs.3.rs-993675/v1 ◽

2021 ◽

Author(s):

Ling-Jan Chiou ◽

Hui-Chu Lang

Keyword(s):

Hospital Readmission ◽

Discharge Planning ◽

Multinomial Logistic Regression ◽

Hospital Readmissions ◽

Care Program ◽

Severity Index ◽

Stroke Severity ◽

Stroke Patients ◽

Post Discharge ◽

Important Indicator

Abstract Readmission is an important indicator of the quality of care. The purpose of this study was to explore the probabilities and predictors of 30-day and 1-year potentially preventable hospital readmission (PPR) after a patient’s first stroke. We used claims data from the National Health Insurance (NHI) from 2010 to 2018. Multinomial logistic regression was used to assess the predictors of 30-day and 1-year PPR. A total of 41,921 discharged stroke patients was identified. We found that hospital readmission rates were 15.48% within 30-days and 47.25% within 1-year. The PPR and non-PPR were 9.84% (4,123) and 5.65% (2,367) within 30-days, and 30.65% (12,849) and 16.60% (6,959) within 1-year, respectively. The factors of older patients, type of stroke, shorter length of stay, higher Charlson Comorbidity Index (CCI), higher stroke severity index (SSI), hospital level, hospital ownership, and urbanization level were associated significantly with the 30-day PPR. In addition, the factors of gender, hospitalization year, and monthly income were associated significantly with 1-year PPR. The results showed that better discharge planning and post-discharge follow-up programs could reduce PPR substantially. Also, implementing a post-acute care program for stroke patients has helped reduce the long-term PPR in Taiwan.

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Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp288 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jonathan Muller ◽

Barbara Gatton ◽

Linda Fox ◽

Joseph A Bove ◽

Johanna Donovan Turner ◽

...

Keyword(s):

Support Groups ◽

Medical Information ◽

Patient Adherence ◽

Hospital Readmissions ◽

Phone Call ◽

Stroke Patients ◽

Post Discharge ◽

Phone Calls ◽

Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

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High Prevalence of Poststroke Depression in Ischemic Stroke Patients in Ethiopia

Neurology Research International ◽

10.1155/2020/8834299 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Fikru Tsehayneh ◽

Abenet Tafesse

Keyword(s):

Depressive Symptoms ◽

Negative Impact ◽

Significant Proportion ◽

Cross Sectional Study ◽

Screening Tools ◽

Limited Information ◽

Poststroke Depression ◽

Stroke Patients ◽

Cross Sectional ◽

Patient Health

Background. There is limited information and research carried out regarding the prevalence of poststroke depression (PSD) in the study area. Psychiatric disorders complicate a significant proportion of patients suffering from stroke. This of course have a great negative impact on our knowledge about poststroke depression in Ethiopia, and poststroke depression complicates a significant number of stroke patients and their rehabilitation. Methods. A cross-sectional study on all patients aged above 18 years and diagnosed with stroke in the past two years who attended the neurology follow-up clinics of Tikur Anbessa Specialized Hospital (TASH) and Zewditu Memorial Hospital (ZMH) was done by using a structured questionnaire containing Patient Health Questionnaire-9 (PHQ-9) depression screening tool. Result. Of 84 patients who were eligible for the study, 32.2% of patients have depressive symptoms. Women (OR 0.001, 95% CI 0.12–0.87) and aphasic patients (OR 0.034, 95% CI 0.19–1.27) were more likely to have depressive symptoms. Conclusion. Depressive symptoms after stroke are common in Ethiopian patients. Our study demonstrates female and aphasic patients are more likely to screen positive for PSD. Hence, screening all poststroke patients with different screening tools is practical, and further studies are needed to assess the validity of these screening tools and also to assess PSD as a predictor of stroke outcome.

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Clinically Relevant Depressive Symptoms in Young Stroke Patients - Results of the sifap1 Study

Neuroepidemiology ◽

10.1159/000371389 ◽

2015 ◽

Vol 44 (1) ◽

pp. 30-38 ◽

Cited By ~ 3

Author(s):

Christian Tanislav ◽

Peter Kropp ◽

Ulrike Grittner ◽

Martin Holzhausen ◽

Franz Fazekas ◽

...

Keyword(s):

Diabetes Mellitus ◽

Depressive Symptoms ◽

Brain Mri ◽

Acute Stage ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Stroke Patients ◽

Mri Findings ◽

Young Stroke ◽

Cerebral Mri

Background: Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. Methods: The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. Results: From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. Conclusion: Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.

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Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽

10.1371/journal.pone.0259806 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259806

Author(s):

Brent Strong ◽

Michele C. Fritz ◽

Liming Dong ◽

Lynda D. Lisabeth ◽

Mathew J. Reeves

Keyword(s):

Depressive Symptoms ◽

Acute Stroke ◽

Recovery Period ◽

Stroke Severity ◽

Stroke Survivors ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Early Recovery Period ◽

Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

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A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care

Translational Behavioral Medicine ◽

10.1093/tbm/ibz171 ◽

2019 ◽

Cited By ~ 2

Author(s):

Shelagh A Mulvaney ◽

Constance A Mara ◽

Jessica C Kichler ◽

Shideh Majidi ◽

Kimberly A Driscoll ◽

...

Keyword(s):

Type 1 Diabetes ◽

Depressive Symptoms ◽

Psychometric Properties ◽

Mental Health Treatment ◽

Clinical Care ◽

Patient Characteristics ◽

Patient Health Questionnaire ◽

Health Questionnaire ◽

Patient Health

Abstract Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.

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Abstract WP394: Needs of Stroke Survivors Post Hospital Discharge Stroke Follow-up Call

Stroke ◽

10.1161/str.48.suppl_1.wp394 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Joseph Mojares ◽

Sherydahn Aldrich ◽

Maria Novales-Fiel

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Hospital Readmissions ◽

Primary Care Providers ◽

Phone Call ◽

Care Providers ◽

Stroke Patients ◽

Post Discharge ◽

Stroke Education

Background: This project attempts to discover the subjective response needs of 30-day post-acute stroke patients and their family members that were treated in two Northern California hospitals. The goal is to determine the functional level of the Stroke Survivor (SS) as measured by the Modified Rankin Scale (mRS) and to identify post-discharge needs. Purpose: The objective of this project is to identify the patient’s mRS score and post-discharge needs. The study includes stroke education reinforcement, primary care physician follow-up, ancillary services follow-up, discern hospital readmissions rates, and increase patient satisfaction. Methods: A list of discharged acute ischemic stroke patients over a three month period was provided to the Stroke Nurse Champion (SNC). A stroke phone call template was created to elicit the patient’s history, diagnosis, and mRS score. Patients with intracranial hemorrhage diagnosis, patients discharged to Skilled Nursing Facilities, and deceased patients were excluded from the study. The SNC performed chart review to determine patient course of hospitalization and stroke care management; places follow-up phone call to patient or family member; and identify the SS needs. When needs were discovered, they were addressed using electronic in-house messaging to patient’s primary care providers and ancillary staff. Results: Of the 63 participants, nine required stroke resource follow-up. The average mRS score of 1.84 revealed the patient’s knowledge of self-management to be 100%. There were 13 cases that needed outpatient therapy and Home Health therapy with mRS >2. The study outcome includes readmission rate of 0.03% (n=2) and stroke patient satisfaction >12.5%. Conclusions: Based on the mRS score, the SS appropriately met the level of care including rehabilitation needs at home. Post discharge needs of SS included psychosocial support, medication modification and appropriate durable medical equipment. Overall, the SS were satisfied with their care with low incidence of hospital readmission due to their stroke education provided during their hospitalization. Further plans for each hospital facility to consider continuing this project or to change the focus to outpatient support services as well.

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Abstract TP394: Stroke Education- Are you REaDy?

Stroke ◽

10.1161/str.47.suppl_1.tp394 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Nicole E Wolber ◽

Laurie Paletz ◽

Nili Steiner ◽

Betty Robertson ◽

Sonia Guerra

Keyword(s):

Call Center ◽

Well Being ◽

Stroke Patients ◽

Post Discharge ◽

Simple Idea ◽

Patient Recall ◽

Occam’S Razor ◽

Number Of Patients ◽

Stroke Education ◽

Occam's Razor

Introduction/Background: Patients stay healthier when informed, making communication the key to better outcomes. An informed and educated patient actively participates in their own treatment, improves outcomes, and reduces length of stay. We call and evaluate every patient 30 days post discharge. We found that many reported either not receiving stroke education, or could not recall if they had received it. The principle of Occam’s razor states: “The simplest idea is usually the best idea.” This principle was utilized to solve our problem. Quality Questions: 1. How do we increase the likelihood that patients will remember that they have received stroke education? 2. How do we assure that patients recall health information provided to them. Methods: Stroke patients are given extensive, personalized stroke education during their admission, and reinforced daily by stroke team. Education materials were given to patients in white folders with a Cedars-Sinai logo. Stroke patients are phoned in 30 days and asked a series of 18 questions to assess well-being & assess patient’s experience during hospital stay, and after discharge. These calls revealed an unusual number of patients who were unable to recall being educated or receiving educational materials. We decided to simply change the stroke education folder from white to bright red. We instructed the call center to use the red folder as a prompt to help the patient recall receiving stroke education. Conclusion: A collaborative approach was used to ascertain an appropriate stimulus for the patient to recall their stroke specific education. Stroke education had to stand out amidst the myriad of information patients are bombarded with in the hospital. The team came up with the simple idea of using a bright red folder. When patients were called the call center would prompt the patient by saying “The stroke education was given to you in a bright red folder.” Prior to implementation of the red folders, only 81.5% of patients recalled receiving stroke education. After implementation of the red folders, 96.8% recalled receiving stroke education. The principle of Occam’s Razor proved to be correct in our study. A very simple idea such as changing the color of the folders to bright red proved to have very meaningful results.

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Abstract 181: Community Paramedicine’s Impact on Readmission Reduction

Stroke ◽

10.1161/str.51.suppl_1.181 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kathy Morrison ◽

Brandon Wattai ◽

Raymond Reichwein ◽

Cesar Velasco ◽

Alicia Richardson

Keyword(s):

Optimal Recovery ◽

Clinic Visit ◽

Transitions Of Care ◽

Phone Call ◽

Social Evaluation ◽

Stroke Patients ◽

Post Discharge ◽

Lengths Of Stay ◽

Community Paramedicine ◽

Comprehensive Stroke Center

Stroke readmissions within 30 days have been identified by the Centers for Medicare & Medicaid Services (CMS) as a measure of hospital quality. Readmitted stroke patients experience greater mortality, longer lengths of stay, and higher cost per stay. This Comprehensive Stroke Center has had a follow up program since 2010 which includes a 48 hour phone nurse call, a 7 day clinical pharmacist phone call, and stroke clinic visit/phone call at 30 days and 90 days. This process produced a 50% readmission reduction between 2013 and 2018, however opportunities to further reduce stroke readmissions remain. Methods: In 2018, a process was launched where specially-trained Community Paramedicine professionals visit stroke patients at home @ 7-10 days post discharge. This visit includes education reinforcement, social evaluation and support, medical examination, and interventions. The model was previously found to demonstrably reduce heart failure readmissions. Referrals are made to this team by coordinators for ischemic and hemorrhagic patients discharged to home or rehab. Findings and needs are communicated directly to relevant health system elements. Results: From July 2018 through June 2019, CP visited 156 (23%) of the 669 patients discharged to home and acute rehab. Only 1 patient (0.6%) of those visited was readmitted, while 52 (10%) of the 513 not visited were readmitted within 30 days. During the visits, they identified key barriers such as medication errors, absence of help in the home (despite having previously reported they would have help), lack of transportation, and overwhelmed caregivers. They ensured that pill organizers were utilized, reviewed upcoming appointments, assisted with arranging transportation, and provided education and helping strategies to caregivers. Feedback from the patients has been overwhelmingly positive. Conclusion: Stroke Centers are accountable to improve stroke patients’ transitions of care at discharge to reduce readmissions and ensure optimal recovery. Community Paramedicine personnel are well-suited to positively impact readmission rates in stroke patients.

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Abstract WP309: Detection of Depressive Symptoms Among Ischemic Stroke Patients not Screened in the Acute Setting

Stroke ◽

10.1161/str.47.suppl_1.wp309 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Anjail Sharrief ◽

Munachi Okpala ◽

Rozina N Wadhwania ◽

Mansoor Mughal ◽

Farhaan Vahidy ◽

...

Keyword(s):

Ischemic Stroke ◽

Depressive Symptoms ◽

Outpatient Setting ◽

Alternative Methods ◽

Depression Screening ◽

Mild Depression ◽

Stroke Patients ◽

Patient Health ◽

Antidepressant Use

Introduction: Depression screening may not be feasible for all stroke patients during their hospitalization, and depression may be missed if screening is not performed in the outpatient setting. Hypothesis: We sought to assess the proportion of patients with depression, and describe the severity of depressive symptoms in patients who could not be screened during hospitalization. We hypothesized that depressive symptoms can be missed in those who are not screened. Methods: Ischemic strokes (July 2014- July 2015) were identified from the clinic registry. In the clinic, we use Patient Health Questionnaire 9 (PHQ-9) to assess depressive symptoms for all patients. Univariate and multivariable linear regression analyses were used to evaluate associations between PHQ-9 and age, sex, race, baseline National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and antidepressant use for patients who missed inpatient depression screening. Results: Among 159 ischemic stroke patients, 136 completed outpatient PHQ-9 within 90 days from stroke onset. Of these 41 (30%) were missing inpatient PHQ-9. Reasons for missing scores included aphasia or cognitive impairment (20), failed inpatient attempt (16), or unspecified reasons (5). Among the 41 patients, median time to follow-up was 40 days (IQR 33 - 50). Mean (SD) age was 63.7 (13.8) and 51.2% were female. Mean (SD) PHQ-9 score was 8.0 (6.61). The overall proportion of patients having at least mild depression was 60.1% (95 % CI 45.3, 76.5) and PHQ-9 scores were distributed as follows: none to minimal depressive symptoms, 39.0%; mild to moderate, 43.9%, moderately severe to severe, 17.1%. In the regression model, mRS at follow-up (dichotomized < 3 & ≥ 3) was associated with severity of depressive symptoms after adjusting for age, sex, and baseline NIHSS, (coefficient 4.1, 95% CI 1.38, 6.82). Other variables were not associated with severity of depressive symptoms. Conclusions: Patients who cannot be screened for depression during hospitalization may have depressive symptoms and should be screened as soon as feasible after discharge. Alternative methods to screen cognitively impaired patients need to be developed.

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