In-hospital initiation of secondary prevention is associated with improved vascular outcomes at 3 months.
ABSTRACT Although various in-hospital stroke quality improvement programs have been associated with high treatment rates at hospital discharge, there are few data on the impact of these programs on clinical outcomes. We evaluated the impact of the PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program on short-term vascular risk.
Prospective data collected after discharge for ischemic stroke or transient ischemic attack caused by presumed atherosclerotic mechanism from a PROTECT intervention hospital and a comparison community hospital, which used conventional care, were compared. The 3-month follow-up clinical outcome data were then evaluated and differences in outcome frequency data between the two hospital groups were analyzed using Fisher's exact test. Covariate adjusted comparisons of percent with a vascular event was computed via logistic regression methods.
A total of 224 patients met study criteria: 126 patients at a PROTECT hospital and 98 patients at a comparator hospital. The 3-month postdischarge data were available for 78 patients at PROTECT hospital versus 65 control patients. Patients at a PROTECT hospital were more likely to be younger, be current smokers, and not have a history of atrial fibrillation. At 3 months, there was a covariate-adjusted difference in the intervention-hospital group versus the control-hospital group with regard to the incidence of a vascular event (transient ischemic attack, stroke, or myocardial infarction), 8.4% versus 22% (P = .036).
Compared with conventional care, PROTECT was associated with better 3-month vascular outcomes after stroke hospitalization. Further study is needed to confirm the potential favorable impact of stroke quality improvement programs on clinical outcomes.
SourceAvailable from: Samantha Hurst[Show abstract] [Hide abstract]
ABSTRACT: There is an urgent need to develop effective strategies to improve stroke outcomes in Sub-Saharan Africa (SSA), where use of evidence-based therapies among patients receiving conventional care is poor. Designs of behavioral interventions to improve stroke care in SSA need to be sensitive to both individual and community factors (including local perceptions and public policies) contributing to the likelihood of compliance with recommended therapeutic goals. This article presents a community-based participatory research protocol that will evaluate systems and processes affecting the continuum of stroke-preventive care in an SSA country. Phase 1 of the Tailored Hospital-based Risk Reduction to Impede Vascular Events study will be implemented from 2013 to 2014 at 4 different types of hospital settings in Nigeria. Six adult stroke survivor focus group discussions and six caregiver focus group discussions, each lasting about 120 minutes will be conducted. Each group will comprise 6 to 8 participants. We will also conduct 22 semi-structured key informant interviews (informed by the Theoretical Domains Framework) with several types of providers and hospital administrators. Purposive and maximum variation sampling will be used to identify and recruit participants from participating hospitals. Transcript data will be analyzed by reviewers in an iterative process to identify recurrent and unifying themes using a constructivist variant of the grounded theory methodology, and will involve participatory co-analysis with key stakeholders to enhance authenticity and veracity of findings. On the basis of the results of Tailored Hospital-based Risk Reduction to Impede Vascular Events phase 1, we intend to develop a culturally sensitive, system-appropriate, multipronged intervention whose efficacy to boost adherence to evidence-based stroke-preventive care will be tested in a future randomized trial (phase 2).Critical pathways in cardiology 03/2014; 13(1):29-35. DOI:10.1097/HPC.0000000000000005
[Show abstract] [Hide abstract]
ABSTRACT: According to the World Health Organization (WHO), more than 80% of worldwide diabetes (DM)-related deaths presently occur in low- and middle-income countries (LMIC), and left unchecked these DM-related deaths will likely double over the next 20years. Cardiovascular disease (CVD) is the most prevalent and detrimental complication of DM: doubling the risk of CVD events (including stroke) and accounting for up to 80% of DM-related deaths. Given the aforementioned, interventions targeted at reducing CVD risk among people with DM are integral to limiting DM-related morbidity and mortality in LMIC, a majority of which are located in Sub-Saharan Africa (SSA). However, SSA is contextually unique: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians currently limit the capacity of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. This article proposes a theory-based framework for conceptualizing integrated protocol-driven risk factor patient self-management interventions that could be adopted or adapted in future studies among hospitalized stroke patients with DM encountered in SSA. These interventions include systematic health education at hospital discharge, use of post-discharge trained community lay navigators, implementation of nurse-led group clinics and administration of health technology (personalized phone text messaging and home tele-monitoring), all aimed at increasing patient self-efficacy and intrinsic motivation for sustained adherence to therapies proven to reduce CVD event risk. Copyright © 2014 Elsevier B.V. All rights reserved.Journal of the Neurological Sciences 11/2014; 348(1-2). DOI:10.1016/j.jns.2014.11.023 · 2.26 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a "bridging" strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care.01/2015; 5(1):35-42. DOI:10.1177/1941874414540683