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  • 1
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    Online Resource
    Methods guiding stakeholder engagement in planning a pragmatic study on changing stroke systems of care
    Cambridge University Press (CUP) ; 2017
    In:  Journal of Clinical and Translational Science Vol. 1, No. 2 ( 2017-04), p. 121-128
    Details
    In: Journal of Clinical and Translational Science, Cambridge University Press (CUP), Vol. 1, No. 2 ( 2017-04), p. 121-128
    Abstract: Background: The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. Methods: We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. Conclusion: In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting pragmatic trials.
    Type of Medium: Online Resource
    ISSN: 2059-8661
    URL: Article
    DOI: 10.1017/cts.2016.26
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2898186-8
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  • 2
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    Abstract TP308: Transitional Care in Stroke Certified and Non-certified Hospitals: The Comprehensive Post-Acute Stroke Services (COMPASS) Study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background: Greater than 50% of stroke patients are discharged home from the hospital, most with continuing care needs. In the absence of evidence-based transitional care interventions for stroke patients, procedures likely vary by hospital even among stroke-certified hospitals with requirements for transitional care protocols. We examined the standard of transitional care among NC hospitals enrolled in the COMPASS study comparing stroke-certified and non-certified hospitals. Methods: Hospitals completed an online, self-administered, web-based questionnaire to assess usual care related to hospitals’ transitional care strategy, stroke program structural components, discharge planning processes, and post-discharge patient management and follow-up. Response frequencies were compared between stroke certified versus non-certified hospitals using chi-squared statistics and Fisher’s exact test. Results: As of July 2016, the first 27 hospitals enrolled (of 40 expected) completed the survey (67% certified as a primary or comprehensive stroke center). On average, 54% of stroke patients were discharged home. Processes supporting hospital-to-home care transitions, such as timely follow-up calls and follow-up with neurology, were infrequent and overall less common for non-certified hospitals (Table). Assessment of post-discharge outcomes was particularly infrequent among non-certified sites (11%) compared with certified sites (56%). Uptake of transitional care management billing codes and quality metrics was low for both certified and non-certified hospitals. Conclusion: Significant variation exists in the infrastructure and processes supporting care transitions for stroke patients among COMPASS hospitals in NC. COMPASS as a pragmatic cluster-randomized trial will compare outcomes among hospitals that implement a CMS-directed model of transitional care with those hospitals that provide highly variable transitional care services.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tp308
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 3 ( 2016-03), p. 836-842
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 3 ( 2016-03), p. 836-842
    Abstract: Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. Methods— Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0–2) was assessed by c -index. Results— There were 815 patients with ischemic stroke (age median, 76 years [interquartile range {IQR}, 70–82]; 46% women; National Institutes of Health Stroke Scale median, 4 [IQR, 2–7] ) from 88 hospitals. The 90-day and 1-year median home-times were 79 (IQR, 52–86) days and 349 (IQR, 303–360) days and median mRS were 2 (IQR, 1–4) and 2 (IQR, 1–4). Greater home-time within 90 days was significantly correlated with lower 90-day mRS (Pearson correlation coefficient, −0.731; P 〈 0.0001) and showed strong ability to discriminate functional independence with mRS 0 to 2 ( c -index, 0.837). Similar findings were observed at 1 year. Conclusions— In a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year. Home-time represents a novel, easily measured, patient-centered, outcome measure for an episode of stroke care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011599
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 4
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    Association of in-hospital depression and anxiety symptoms following stroke with 3 months- depression, anxiety and functional outcome
    Elsevier BV ; 2022
    In:  Journal of Clinical Neuroscience Vol. 98 ( 2022-04), p. 133-136
    Details
    In: Journal of Clinical Neuroscience, Elsevier BV, Vol. 98 ( 2022-04), p. 133-136
    Type of Medium: Online Resource
    ISSN: 0967-5868
    URL: Article
    DOI: 10.1016/j.jocn.2022.02.010
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2009190-4
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  • 5
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    Online Resource
    The association between socioeconomic status and disability after stroke: Findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry
    Springer Science and Business Media LLC ; 2014
    In:  BMC Public Health Vol. 14, No. 1 ( 2014-12)
    Details
    In: BMC Public Health, Springer Science and Business Media LLC, Vol. 14, No. 1 ( 2014-12)
    Type of Medium: Online Resource
    ISSN: 1471-2458
    URL: Article
    DOI: 10.1186/1471-2458-14-281
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2014
    detail.hit.zdb_id: 2041338-5
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  • 6
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    Comprehensive Stroke Care and Outcomes : Time for a Paradigm Shift
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 1 ( 2021-01), p. 385-393
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 1 ( 2021-01), p. 385-393
    Abstract: Worldwide, stroke is prevalent, costly, and disabling in 〉 80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors’ and caregivers’ perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines–Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients’ and caregivers’ strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.029678
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Abstract 90: Socioeconomic Status Is Associated With Disability Following Acute Ischemic Stroke: Findings From The Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p 〈 0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A90
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 8
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    Chronic Stroke Outcome Measures for Motor Function Intervention Trials : Expert Panel Recommendations
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 8, No. 6_suppl_3 ( 2015-10)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 6_suppl_3 ( 2015-10)
    Abstract: About half of survivors with stroke experience severe and significant long-term disability. The purpose of this article is to review the state of the science and to make recommendations for measuring patient-centric outcomes in interventions for motor improvement in the chronic stroke phase. Methods and Results— A 9-member expert panel reviewed evidence to identify measures of upper and lower extremity function used to date as outcomes in trials with patients who experienced a stroke ≥6 months before assessment. Outcome measures were screened using StrokEDGE consensus panel recommendations, and evaluated for availability of a published minimal clinically important difference. Measures meeting these criteria were further evaluated with regard to their level of measurement, psychometric properties, and ability of minimal clinically important difference to capture gains associated with improved function and clinical relevance to patients, to arrive at recommendations. A systematic literature review yielded 115 clinical trials of upper and lower extremity function in chronic stroke that used a total of 34 outcome measures. Seven of these had published minimal clinically important differences and were recommended or highly recommended by StrokEDGE. Those are the Fugl-Meyer Upper Extremity and Lower Extremity scales, Wolf Motor Function Test, Action Research Arm Test, Ten-Meter and Six-Minute Walk Tests, and the Stroke Impact Scale. All had evidence for their psychometric performance, although the strength of evidence for validity varied, especially in populations with chronic stroke Fugl-Meyer Upper and Lower Extremity scales showing the strongest evidence for validity. Conclusions— The panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/CIRCOUTCOMES.115.002098
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2453882-6
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  • 9
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    Abstract WP297: Healthcare Transitions, Service Use, and Home-time Among Stroke Survivors With Depression
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Depression following an acute ischemic stroke (AIS) is associated with poor functional recovery, less social activity, and mortality. Patterns of health service use in the 90 days after an AIS have not been described by depression severity. Methods: Data from Get With The Guidelines-Stroke and a prospective cohort of AIS patients enrolled in the AVAIL (Adherence eValuation After Ischemic Stroke Longitudinal) study were linked with Medicare claims. AVAIL patients depressive symptoms were measured by the PHQ-8 90 days after hospital discharge by phone and categorized as no/minimal depression (0-4), mild (5-9), and moderate-severe (≥10). The number of transitions was defined as the number of acute and post-acute inpatient and outpatient services in the claims data within 90 days of the index admission. Home-time was the number of days alive and out of inpatient care. Differences in clinical characteristics and service use were evaluated between depression severity groups. Results: Of 538 AIS patients examined, 63% had no/minimal depression, 24% mild and 14% had moderate-severe depression 90-days post-stroke. Patients experienced up to 6 care transitions in 90-days; the 10 most common care patterns representing 80% of this sample (Figure). Across categories of increasing depression severity (no/minimal, mild, moderate-severe), use of services increased from no/minimal to those with depression (% with ≥1 service after discharge: 71%, 87%, 85%; p=0.002), and home time decreased (mean±SD: 82±16, 75±23, 77±23; p=0.006), although rehospitalization within 90 days was 19% for each group (p=0.984). Conclusion: This study demonstrates an association between post-stroke depression and worse outcomes following stroke. Research is needed to determine whether targeted care coordination interventions can improve outcomes among stroke patients with depression.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp297
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 10
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    Abstract WP311: In-hospital Depression and Anxiety and History of Depression Predict 3 Months Post-stroke Depression and Anxiety
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Multiple factors may impact a patient’s response on a depression screen during hospitalization for stroke. The EQ-5D-3L is a standardized measure for use as a health outcome, and comprises the dimension of anxiety/depression. We examined the relationship between pre-hospital history of depression and in-hospital and 3 months anxiety/depression on EQ-5D. Methods: We captured 3-month outcomes on patients with stroke or TIA discharged home between September 2011 and April 2015. EQ-5D-3L dimension of anxiety/depression at 3 months dichotomized as “no symptoms” or “at least some symptoms” was the primary outcome. Two stepwise logistic regression models adjusting for age, history of congestive heart failure , and baseline NIHSS were generated: 1) using pre-hospital depression as the main predictor (N=124) and 2) using in-hospital depression as the main predictor (N=69 because of missing data in this variable). History of pre-hospital depression and in-hospital depression were highly correlated with each other and were not included in the same model. Results: The sample included 124 patients (98 with ischemic stroke, 18 hemorrhagic strokes and 8 TIA). The mean age was 66.0 y (SD12.3), 45% women, 73% white, and mean NIHSS 4.0 + 5.2. Anxiety/depression was reported by 30/69 (43%) subjects in the hospital and by 23/124 (18%) at three months post-stroke. In the first model, previous history of depression was associated with 3 months EQ-5D-3L anxiety/depression (p=0.038). In the second model, in-hospital anxiety/depression was associated with 3-month EQ-5D-3L anxiety/depression (p=0.027) (table). Conclusion: Self-reported depressive and anxiety symptoms in the hospital and history of depression were associated with 3 months post-stroke depression and anxiety. This confirms the importance of screening in subjects with acute stroke for history of depression and for in-hospital depression/anxiety.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp311
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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