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Michigan Stroke Transitions Trial.

Mathew J Reeves1, Michele C Fritz1, Amanda T Woodward2

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Circulation. Cardiovascular Quality and Outcomes
|July 13, 2019
PubMed
Summary
This summary is machine-generated.

Combining social worker-led case management (SWCM) with a stroke information website improved patient physical health and activation post-stroke compared to usual care. This combined approach showed greater gains than SWCM alone, but did not impact mental health.

Keywords:
case managementclinical trialpatient reported outcomessocial workerstroketransitional care

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Area of Science:

  • Clinical Medicine
  • Neurology
  • Health Services Research

Background:

  • Stroke significantly impacts patient-reported outcomes, necessitating effective post-discharge interventions.
  • Usual care may not fully address the complex needs of stroke survivors.
  • Social worker-led case management (SWCM) and digital health information are potential adjuncts to usual care.

Purpose of the Study:

  • To evaluate if home-based SWCM or SWCM combined with a stroke information website improves patient-reported outcomes compared to usual care.
  • To assess the impact of these interventions on physical health, mental health, and patient activation.

Main Methods:

  • A 3-group parallel-design clinical trial (MISTT) randomized 265 acute stroke patients.
  • Interventions included Usual Care, SWCM (in-home/phone), and SWCM + MISTT website (stroke information).
  • Outcomes (PROMIS Global-10, Patient Activation Measure) were assessed at 7 and 90 days.

Main Results:

  • The SWCM + MISTT website group showed significantly greater improvement in Physical Health (P=0.003) and Patient Activation (P=0.042) compared to usual care.
  • SWCM + MISTT website also demonstrated significantly higher Physical Health gains than SWCM alone (P=0.02).
  • No significant intervention effect was observed for Mental Health (P=0.56).

Conclusions:

  • Combining SWCM with a stroke information website enhances patient-reported physical health and activation more effectively than SWCM alone or usual care.
  • The digital component of the intervention appears crucial for maximizing patient engagement and recovery.
  • Further research should explore strategies to improve mental health outcomes in stroke survivors.