title: Effectiveness of a postdischarge care management model for stroke and transient ischemic attack: a randomized trial.
abstract: BACKGROUND
  This randomized controlled trial tested the effectiveness of comprehensive, interdisciplinary postdischarge care management in improving a profile of indicators of health recovery and secondary prevention (profile of health and prevention) in stroke and transient ischemic attack (TIA) patients.
  
  
  METHODS
  Ninety-six stroke/TIA patients were randomized to usual care or intervention at discharge from our acute stroke unit. The intervention group received an in-home biopsychosocial assessment by an advanced practice nurse at 1 month. A care plan was developed by an interdisciplinary team and implemented in collaboration with the patient's primary care physician. The profile of health and prevention, measured at 3 months, was comprised of 5 domains: (1) Neuromotor Function, (2) Severe Complications, (3) Quality of Life, (4) Management of Risk for common poststroke complications and recurrent stroke, and (5) Stroke Knowledge. A single global hypothesis test across multiple end points was used to compare the 2 groups.
  
  
  RESULTS
  The intervention significantly improved the profile of health and prevention (P < .0001). In addition, each domain showed a positive effect of the intervention. Effect sizes (in standard deviation units) of the intervention on domains were .1 for Neuromotor Function (90% confidence interval [CI] = -.3 to .5); .4 for Severe Complications (90% CI = .1 to .8); .5 for Quality of Life (90% CI = .1 to .9); .6 for Management of Risk for common poststroke complications and recurrent stroke (90% CI = .3 to 1.); and 1.0 for Stroke Knowledge (90% CI = .6 to 1.4).
  
  
  CONCLUSIONS
  This model of care management resulted in a significantly better profile of health and prevention for stroke/TIA patients 3 months postdischarge.
authors: Summa Health System, Akron, OH, USA. allenk@summa-health.org
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