title: [Organized Post-Stroke Care through Case Management on the Basis of a Standardized Treatment Pathway : Results of a Single-Centre Pilot Study].
abstract: BACKGROUND
  Post-stroke care programs based on a standardized treatment pathway supported by case management may prevent secondary stroke and minimize risk factors.
  
  
  OBJECTIVE
  We aimed to determine the feasibility of a standardized treatment pathway and its impact on risk factor control, life-style changes and adherence to secondary prevention medication.
  
  
  METHODS
  We conducted a prospective pilot study in consecutive stroke patients. The 12-month post-stroke care program included regular perosnal and phone contact with a certified case manager. Target values for vascular risk factors following current recommendations of stroke guidelines were monitored and treated if necessary. In the case of deviations from the treatment pathway the case manager intervened. Patients were screened for recurrent stroke at the end of the program after 12 months.
  
  
  RESULTS
  We enrolled 101 patients: 57.4 % were male, the median age was 72 (IQR, 62-80) years, median baseline NIHSS score was 2(IQR, 1-5), 79.2 % had an ischemic stroke, 3 % a hemorrhagic stroke, and 17.8 % a transient ischemic attack (TIA). Eighty-six (85.1 %) patients completed the program, 12 (11.9 %) withdrew from the program and 3 died of malignant diseases. In total, 628 personal (6.2/patient) and 2,683 phone contacts (26.6/patient) were conducted by the case manager. Three hundred-seventy-nine specific interventions were necessary mostly because of missing medication, non-compliance, and social needs. After 12 months, target goals for blood pressure, body mass index, nicotine use, and cholesterol were more frequently (p < 0.05) achieved than at baseline. No recurrent stroke occurred during the program.
  
  
  CONCLUSIONS
  Our pilot data demonstrate that case management-based post-stroke care is feasible and may contribute to effective secondary prevention of stroke.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland. Jessica.Barlinn@uniklinikum-dresden.de.|Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland. Jessica.Barlinn@uniklinikum-dresden.de.
authors.forename: J
authors.initials: J
authors.lastname: Barlinn
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Helbig
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.|Cardiovascular Clinical Research Facility, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: T
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: L-P
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Urban
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: V
authors.initials: V
authors.lastname: Pütz
authors.affiliation: Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Schmitt
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Reichmann
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus Dresden, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
authors.forename: U
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D000359:Aftercare / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000592:standards / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D015995:Prevalence; D055502:Secondary Prevention / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*
keywords: Case management; Post-stroke care; Secondary stroke prevention; Stroke