title: A randomized trial testing the superiority of a postdischarge care management model for stroke survivors.
abstract: OBJECTIVE
  We sought to evaluate whether comprehensive postdischarge care management for stroke survivors is superior to organized acute stroke department care with enhanced discharge planning in improving a profile of health and well-being.
  
  
  METHODS
  This was a randomized trial of a comprehensive postdischarge care management intervention for patients with ischemic stroke and National Institutes of Health Stroke Scale scores greater than or equal to 1 discharged from an acute stroke department. An advanced practice nurse performed an in-home assessment for the intervention group from which an interdisciplinary team developed patient-specific care plans. The advanced practice nurse worked with the primary care physician and patient to implement the plan during the next 6 months. The intervention and usual care groups were compared using a global and closed hypothesis testing strategy. Outcomes fell into 5 domains: (1) neuromotor function, (2) institution time or death, (3) quality of life, (4) management of risk, and (5) stroke knowledge and lifestyle.
  
  
  RESULTS
  Treatment effect was near 0 SD for all except the stroke knowledge and lifestyle domain, which showed a significant effect of the intervention (P = .0003).
  
  
  CONCLUSIONS
  Postdischarge care management was not more effective than organized stroke department care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a postdischarge knowledge gap.
authors.affiliation: Health Services Research and Education Institute, Department of Medicine, Summa Health System, Akron, Ohio 44304, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Allen
authors.forename: Susan
authors.initials: S
authors.lastname: Hazelett
authors.forename: David
authors.initials: D
authors.lastname: Jarjoura
authors.forename: Keding
authors.initials: K
authors.lastname: Hua
authors.forename: Kathy
authors.initials: K
authors.lastname: Wright
authors.forename: Janice
authors.initials: J
authors.lastname: Weinhardt
authors.forename: Denise
authors.initials: D
authors.lastname: Kropp
mesh_terms: D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007902:Length of Stay; D008297:Male; D009043:Motor Activity; D010348:Patient Care Team; D010351:Patient Discharge; D011788:Quality of Life; D012008:Recurrence; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome