Improving Transition of Care for Stroke Survivors with Hospital and Post-Acute Education
AuthorBajaj, Nina Raeleen Herrera
Keywordseffective stroke education
providing stroke education
stroke education strategy
transition of care
transition of care of stroke patients
MetadataShow full item record
PublisherThe University of Arizona.
RightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
AbstractBackground: Transitioning from the hospital to home is linked with emotional, social, and health-related problems (Reeves et al., 2017). These transitions are ultimately and importantly linked to the safety of post-acute stroke survivors A basic strategy in improving challenges related to transitional care is providing better stroke education to patients and caregivers (Sanders et al., 2014; Reeves et al., 2017). Purpose: The purpose of this project is to evaluate stroke knowledge retention among Transient Ischemic Attack (TIA), stroke survivors or caregivers when they return home (14-30 days after discharge). Specifically, this project analyzed selected demographics (age, gender, type of stroke, discharge location) and assessed 1) stroke knowledge (stroke type and risk factors) and 2) the impact of the stroke education book (did they remember receiving the book and if so did they refer to it and was it helpful) that was provided to the patient and caregivers by the Comprehensive Stroke Center. Design and Methods: A quality improvement project which performed a secondary analysis of data that has been previously collected by a Comprehensive Stroke Center Transition of Care program +/- 30 days post hospital discharge. Data that has been collected included patient demographics, stroke knowledge and usefulness of a newly developed stroke education book. Results: Reponses of patients and caregivers (N=105) were included. The sample included mostly ischemic stroke and TIA patients. Less than half of the participants said they received stroke education or the newly developed stroke education book even though, according to the stroke coordinator, there is nearly 100% compliance in providing stroke education book documented in patients’ charts. Further, more than half of the participants who said they received a stroke education book did not refer to the book for any reason. Some of the participants who read the book reported not understanding it. Conclusion: There is lack of knowledge regarding stroke diagnosis and risk factors despite having educational material provided to patients/caregivers. A stroke education book is likely necessary but is not sufficient. There is a need for developing active, individualized in-hospital education as well as a need for early discharge follow up to reinforce education in order to ensure safe transitions when patients return home after experiencing stroke.
Degree ProgramGraduate College
Degree GrantorUniversity of Arizona
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Measurement of Patients' Perceptions of the Quality of Acute Stroke Services: Development and Validation of the STROKE Perception ReportAlexandrov, Anne W; Brewer, Barbara B; Moore, Kari; Grau, Charlene; Beenstock, Dana J; Cudlip, Fern; Murphy, Deborah A; Klassman, Lynn; Korsnack, Andrea M; Johnson, Brenda; et al. (LIPPINCOTT WILLIAMS & WILKINS, 2019-10)INTRODUCTION: Patients' perceptions of healthcare quality have become an important part of quality measurement. We explored patients' and family's lived experiences during acute stroke hospitalization to develop a quantitative instrument. METHODS: Focus groups were conducted using open-ended scripted questions. Interview data were coded and analyzed using an inductive approach to thematic analysis. Symmetric patient and family instruments were developed based on qualitative domains and serially refined to a set of 30 survey items, 12 stroke knowledge test items, and 5 subject demographic fields. Scales were evaluated for internal consistency reliability using Cronbach alpha; construct validity with exploratory factor analysis using principal components with varimax rotation was performed to determine the extent to which items in a scale measure the same underlying factor. Feasibility of an electronic cloud-based survey was also tested. RESULTS: Three main themes emerged: fast action to diagnose and treat stroke, genuine caring, and education to prevent and respond to stroke. A total of 1029 subjects completed the final instrument with no differences in perception found by race, ethnicity, or length of stay. Scales showed satisfactory internal consistency reliability (Cronbach alpha scores, .89-.94); factor loadings across each scale ranged from 0.55 to 0.87. Data entry by electronic pad was perceived by 77% to be more confidential than paper surveys; median score for difficulty was 4 ("easy to use"). CONCLUSION: The STROKE Perception Report enables understanding of patients' and family's beliefs about the quality of acute stroke care in essential new domains never explored before.
Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trialSit, Janet WH; Chair, Sek Ying; Choi, KC; Chan, Carmen WH; Lee, Diana TF; Chan, Aileen WK; Cheung, Jo LK; Tang, Siu Wai; Chan, Po Shan; Taylor-Piliae, Ruth E; et al. (DOVE MEDICAL PRESS LTD, 2016-10)Background: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. Purpose: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. Methods: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. Results: A total of 210 (CG = 105, IG = 105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P, 0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. Conclusion: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.