Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program.
Stroke
BACKGROUND:The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program. METHODS:We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022. We quantified temporal changes in performance measure adherence and clinical outcomes over time. Performance measure denominators consisted of patients who were eligible, excluding those with contraindications. RESULTS:Over the 20 years of the program, a total of 7837 849 stroke cases (median age 71 years, 51.0% female; 69.2% ischemic strokes, 3.9% SAHs, 11.5% ICHs, and 15.3% TIAs) were entered into the registry. Except for antithrombotics at discharge, in which the baseline performance was >92%, there was sustained improvement in all performance metrics regardless of type of cerebrovascular event (<0.01 for all). In patients with acute ischemic stroke, large improvements were observed for anticoagulation for atrial fibrillation (55.7% in 2003 to 97.2% in 2022), smoking cessation counseling (44.7%-97.8%), dysphagia screening (53.8%-83.5%), thrombolytic treatment for patients arriving by 3.5 hours, treat by 4.5 hours (15.2%-92.9%), door-to-needle time within 60 minutes (19.0%-75.3%), and endovascular door-to-puncture time within 90 minutes (54.7%-62.8%). Similar improvements were also observed for measures relevant to patients with subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack. Multivariable analysis showed that there was a sustained increase in odds of receiving each performance measure over time, independent of patient and hospital characteristics for each type of cerebrovascular event. After risk adjustment, there were temporal trends that patients were less likely to be discharged to a skilled nursing facility, and, for ischemic stroke only, more likely to be discharged directly home. CONCLUSIONS:During the first 20 years, Get With The Guidelines-Stroke participation was associated with sustained improvement in evidence-based care and outcomes for patients with stroke and transient ischemic attack in the United States.
10.1161/STROKEAHA.124.048174
Risk prediction model for poor prognosis after intravenous thrombolysis among ischemic stroke patients aged ≥ 80 years and analysis of follow-up.
Scientific reports
To develop and validate practical prediction tools to estimate poor outcomes in patients ≥ 80 years old with acute ischemic stroke after intravenous alteplase thrombolysis, aiding clinical decision-making.To explore the longest benefit window after thrombolysis in the elderly. 1: A retrospectively analysis was conducted on acute stroke patients who underwent intravenous thrombolysis. Patients aged ≥ 80 years were compared to those aged 60-79 years, with a focus on the incidence of symptomatic intracranial hemorrhage, mortality, and poor functional outcome (modified Rankin Score ≥ 2 at 90 days post-thrombolysis). R software was utilized to develop a clinical prediction model and perform internal validation. 2: Ninety days, 180 days, and one year were designated as follow-up time points for all patients. 1.Patients aged ≥ 80 years had higher 90-day poor outcome and mortality (P < 0.001).However, there was no significant difference in symptomatic intracranial hemorrhage between the two groups (P > 0.05).Baseline NIHSS score (OR, 1.15; 95% CI,1.07-1.23; P < 0.001) and admission blood glucose (OR, 1.36; 95% CI,1.11-1.74; P = 0.007) were identified as independent predictors of poor prognosis at 90 days.The area of the prediction model under the receiver operator characteristic curve was 0.77. An online prognostic calculator was developed.2.There was no further improvement in mRS Score in the elderly group after 180days (P < 0.05). (1)The prediction model can estimate the poor outcome of patients aged ≥ 80 years with acute ischemic stroke after intravenous alteplase thrombolysis.The predictors are readily derived at admission.The prediction calculator( https://80ivtr.shinyapps.io/dynnomapp/ ) can be used as a popular tool for physicians. (2)The total duration of benefit after intravenous thrombolysis for patients aged ≥ 80 years is 180 days, while it is at least 1 year for patients between 60 and 79 years.
10.1038/s41598-024-84912-0
Patient and Family Member Factors Influencing Outcomes of Poststroke Inpatient Rehabilitation.
Fang Yunhua,Tao Qian,Zhou Xiaoxuan,Chen Shanjia,Huang Jia,Jiang Yingping,Wu Yi,Chen Lidian,Tao Jing,Chan Chetwyn C
Archives of physical medicine and rehabilitation
OBJECTIVE:To investigate how family members' attitudes toward functional regain, and patients' knowledge and intention of independence influence poststroke rehabilitation. DESIGN:Cross-sectional study. SETTING:Three rehabilitation inpatient settings. PARTICIPANTS:Younger (n=79) and older (n=84) poststroke patients, along with their family members (spouses, n=104; children, n=59). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Custom-designed questionnaires were used to tap into the patients' knowledge about rehabilitation (Patient's Rehabilitation Questionnaire-Knowledge About Rehabilitation) and intention of independence (Patient's Rehabilitation Questionnaire-Intention of Independence), and family members' attitudes toward patients in performing basic activities of daily living (BADL) (Family Member Attitudes Questionnaire-BADL) and instrumental activities of daily living (Family Member Attitudes Questionnaire-instrumental activities of daily living). The rehabilitation outcomes included gains in motor, cognitive, and emotional functions, and self-care independence, measured with common clinical instruments. RESULTS:The Family Member Attitudes Questionnaire-BADL predicted cognitive outcome and the Patient's Rehabilitation Questionnaire-Intention of Independence predicted motor outcome for both groups. Differential age-related effects were revealed for the Patient's Rehabilitation Questionnaire-Intention of Independence in predicting emotional outcome only for the younger group, and self-care independence only for the older group. CONCLUSIONS:Patients' intention of independence positively affected motor recovery, while family members' positive attitudes promoted cognitive regain. The findings suggested plausible age-related differences in how patients' intentions affect emotion versus self-care independence outcomes. Future studies should explore strategies for promoting positive attitudes toward independence among patients and family members during poststroke rehabilitation.
10.1016/j.apmr.2016.07.005
Stroke.
Lancet (London, England)
Stroke affects up to one in five people during their lifetime in some high-income countries, and up to almost one in two in low-income countries. Globally, it is the second leading cause of death. Clinically, the disease is characterised by sudden neurological deficits. Vascular aetiologies contribute to the most common causes of ischaemic stroke, including large artery disease, cardioembolism, and small vessel disease. Small vessel disease is also the most frequent cause of intracerebral haemorrhage, followed by macrovascular causes. For acute ischaemic stroke, multimodal CT or MRI reveal infarct core, ischaemic penumbra, and site of vascular occlusion. For intracerebral haemorrhage, neuroimaging identifies early radiological markers of haematoma expansion and probable underlying cause. For intravenous thrombolysis in ischaemic stroke, tenecteplase is now a safe and effective alternative to alteplase. In patients with strokes caused by large vessel occlusion, the indications for endovascular thrombectomy have been extended to include larger core infarcts and basilar artery occlusion, and the treatment time window has increased to up to 24 h from stroke onset. Regarding intracerebral haemorrhage, prompt delivery of bundled care consisting of immediate anticoagulation reversal, simultaneous blood pressure lowering, and prespecified stroke unit protocols can improve clinical outcomes. Guided by underlying stroke mechanisms, secondary prevention encompasses pharmacological, vascular, or endovascular interventions and lifestyle modifications.
10.1016/S0140-6736(24)00642-1
Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals.
Annals of physical and rehabilitation medicine
BACKGROUND:Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. OBJECTIVE:To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. METHODS:A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. RESULTS:From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective. CONCLUSION:Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
10.1016/j.rehab.2024.101824
Challenges in Accessing Community-Based Rehabilitation and Long-Term Care for Older Adult Stroke Survivors and Their Caregivers: A Qualitative Study.
Journal of multidisciplinary healthcare
Background and Objectives:While extensive research has examined the rehabilitation challenges faced by stroke survivors, there is limited literature addressing the difficulties encountered by older adult stroke survivors and their caregivers in accessing rehabilitation and long-term care within the Chinese community. This study aimed to investigate the specific challenges related to access, quality, and coordination of rehabilitation and long-term care experienced by older adult stroke survivors and their caregivers within the Chinese community. Methods:A qualitative phenomenological design was employed to explore the lived experiences of stroke survivors and their caregivers within the Chinese community. A purposive sampling method was used to recruit participants from June to August 2023. Participants engaged in face-to-face semi-structured interviews. The data were analyzed using an inductive thematic analysis approach to identify and understand key themes and sub-themes. Results:The study involved 38 participants, consisting of 21 older adult stroke survivors (13 males, 8 females) and 17 family caregivers (7 males, 10 females), recruited from five Chinese community health service stations. The analysis identified four distinct themes and 11 sub-themes that encapsulated the challenges faced by participants. These themes include (1) Difficulties in accessing medical services (insufficient medical resources, lack of rehabilitation resources, and time-consuming processes), (2) Challenges in daily life (inconvenience in daily mobility, inadequate financial support, and difficulties in applying for home care services), (3) Psychosocial stress (loneliness, powerlessness, and worry about burdening others), (4) Insufficient information (lack of awareness of available community services, and limited public health education activities). Conclusion:Older adult stroke survivors and their caregivers in Chinese communities face significant challenges. To improve their well-being and quality of life, it is crucial to address these challenges through enhanced access to healthcare, better support for daily living, and more effective information dissemination. Meeting these needs requires a coordinated effort from healthcare providers, community stakeholders, and policymakers to develop and implement effective, long-term care solutions.
10.2147/JMDH.S476993
Subjective Cognitive Dysfunction in Chronic Illness: A Systematic Review and Meta-Synthesis.
Western journal of nursing research
BACKGROUND:Qualitative studies have examined the experiences of subjective cognitive dysfunction in specific populations or specific disease stages, but there has not yet been a systematic synthesis and evaluation of findings related to perceptions of subjective cognitive dysfunction in nondementia-related chronic illnesses. OBJECTIVE:The aim of this study was 2-fold: (1) to undertake a systematic review of experiences of subjective cognitive dysfunction in people with nondementia-related chronic disease and (2) to develop an explanatory framework to describe the experiences of living with subjective cognitive dysfunction. METHODS:Four databases were systematically searched for studies on subjective cognitive dysfunction up to June 2023. Qualitative synthesis was conducted on the final sample (N = 25) using Sandelowski's adaptation of Nobilt and Hare's reciprocal transactional analysis method. Critical appraisal was completed using the Critical Appraisal Skills Programme checklist. RESULTS:Through constant comparison of key concepts, findings were organized within 4 interrelated themes that informed a conceptual explanatory model of adapting to living with subjective cognitive dysfunction: (1) symptoms, (2) health care, (3) perceptions of self, and (4) relationships. Participants highlighted how subjective cognitive dysfunction affected interactions in health care settings and involved other symptoms that in turn complicated meaning, self-enhancement, and mastery. CONCLUSIONS:Our model of the process of adapting provides a new way to conceptualize cognitive dysfunction in chronic illness and suggests opportunities for health care professionals to support patients and their families. The results highlight the need for more research to better understand the role of subjective cognitive dysfunction in nondementia-related chronic illnesses.The review protocol was registered in PROSPERO (CRD42021231410).
10.1177/01939459241272039
A longitudinal investigation of the determinants of stroke survivors' utilisation of a healthy lifestyle for stroke rehabilitation in Australia.
Scientific reports
This study aimed to determine the longitudinal predictors of lifestyle behaviours among stroke survivors in New South Wales, Australia. This longitudinal study utilised data from the baseline survey (2005-2009) and a sub-study survey (2017) of the 45 and Up Study. Physical activity, alcohol consumption, smoking status, and supplement use were included as dependent variables. Generalised estimating equation models were employed to assess the longitudinal association between the dependent variable and demographic and health status measures. The average age of the participants (n = 576) was 67 (SD = 9) years at baseline and 76 (SD = 9) years at the sub-study survey time, with 54.9% being male. The longitudinal analysis revealed that the likelihood of moderate/high physical activity significantly declined over time and was lower among participants with diabetes, but was higher among those with university education. The likelihood of smoking was significantly higher in females, moderate/high-risk alcohol consumers, and those with depression, but was lower among supplement users. The likelihood of moderate/high-risk alcohol consumption significantly declined with time, and was lower among females, but higher among smokers. The likelihood of supplement use significantly declined over time, but was higher among females and/or those with asthma. Our findings help illustrate that many stroke survivors may benefit from further support in adopting and maintaining a healthy lifestyle as part of their stroke management and long-term rehabilitation, which is crucial to optimising their quality of life and successful secondary stroke prevention.
10.1038/s41598-024-78069-z
Disparities in Access to, Use of, and Quality of Rehabilitation After Stroke in the United States: A Scoping Review.
Archives of physical medicine and rehabilitation
OBJECTIVES:To summarize current reports in the literature on disparities in rehabilitation after stroke; identify gaps in our understanding of rehabilitation disparities; and make recommendations for future research. DATA SOURCES:A health sciences librarian developed a search string based on an a priori protocol and searched Medline (Ovid) Embase (Elsevier), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL and EBSCO). STUDY SELECTION:A 2-step screening process of titles and abstracts followed by full-text review was conducted. Primary observational studies conducted in the United States that reported on disparities in rehabilitation (ie, physical, occupational, or speech therapy) among adults after stroke were retained. Eligible disparity populations included racial minorities; ethnic minorities; sex and gender minorities; older populations; socioeconomically disadvantaged populations; and geographic minorities (inner city/rural). DATA EXTRACTION:Data extracted from retained articles included: aims/objectives; data source; sample characteristics, rehabilitation outcomes examined; types of disparities examined; statistical methods used; and disparity findings. DATA SYNTHESIS:Seven thousand eight hundred fifty-three titles and abstracts were screened, and 473 articles underwent full-text review. Forty-nine articles were included for data extraction and analysis. Many articles examined more than 1 disparity type with most examining disparities in race and/or ethnicity (n=43, 87.7%), followed by sex (n=25, 53.0%), age (n=23, 46.9%), socioeconomic status (n=22, 44.9%), and urban/rural status (n=8, 16.3%). Articles varied widely by sample characteristics, data sources, rehabilitation outcomes, and methods of examining disparities. CONCLUSIONS:Although we found some consistent evidence of disparities in rehabilitation for older individuals, non-White races, and individuals of lower socioeconomic status, the variability in methods made the synthesis of findings challenging. Further work, including additional well-designed studies and systematic reviews, and/or meta-analyses of current studies, is needed to better understand the extent of rehabilitation disparities after stroke.
10.1016/j.apmr.2024.10.010
The Minimal assessment Protocol for Cerebral Stroke 2020 (PMIC2020): a multicenter feasibility study in post-stroke inpatient rehabilitation.
European journal of physical and rehabilitation medicine
BACKGROUND:In 2008, a Working Group of the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the first minimum protocol for assessing stroke patients (PMIC) to define functional needs and outcomes. The recent PMIC revision (PMIC2020) introduces a document for all rehabilitation settings, incorporating updated measurement tools. AIM:The aim of this study was to investigate the PMIC2020 feasibility and administration time (AT) in post-stroke inpatients and to examine the influence of demographic and clinical variables on AT. DESIGN:Multicenter prospective observational study. SETTING:Eight Italian rehabilitation centers for post-acute inpatients. POPULATION:Adult patients consecutively admitted to rehabilitation after ischemic/hemorrhagic stroke, reporting the first event or recurrence, with a modified Barthel Index (mBI)<75 points, without cognitive impairment and clinical instability. METHODS:PMIC2020 was administered at admission (T0) and discharge (T1), recording AT of each section/ tool. A feasibility questionnaire was administered to assessors. Univariate and multivariate analyses were conducted to investigate the effect of demographics and clinical variables on AT. RESULTS:One hundred fifty-one subjects were enrolled at T0 and 139 at T1; the mean±SD AT (seconds) was 1634±401 at T0 and 1087±360 at T1 (P<0.001). National Institute of Health-Stroke Scale and Mini-Mental State Examination required the highest AT. All but two scales had significantly lower AT at T1 (P<0.05). Severe disability (as measured by mBI) was associated with higher AT than either complete or minimal/absent disability. The feasibility questionnaire showed good PMIC2020 appraisal by assessors without relevant critical issues. CONCLUSIONS:PMIC2020 was feasible in post-acute inpatient rehabilitation settings. No relevant critical issue was raised by users. Even though more comprehensive than PMIC, PMIC2020 required only slightly more AT (27 minutes at T0 and 18 minutes at T1, on average); more AT was needed to assess patients with severe disability. CLINICAL REHABILITATION IMPACT:The study has immediate transferability for the National Health Service, as PMIC2020 can be routinely implemented in clinical practice and research to assess stroke patients' needs and outcomes. The updated measures allow more immediate comparisons with international data on stroke rehabilitation. Future research should investigate the PMIC2020 feasibility in other rehabilitation settings and its relevance in predicting stroke rehabilitation needs and outcomes.
10.23736/S1973-9087.24.08476-4
Exceptional improvement in chronic stroke through Guided Self-rehabilitation Contract: a case report study.
Frontiers in rehabilitation sciences
A 44-year-old woman suffered a carotid dissection causing a deep and superficial right middle cerebral artery stroke in October 2013, despite undergoing thrombolysis and thrombectomy. Sixteen months later, massive left upper extremity impairment persisted. She then agreed to embark upon a guided self-rehabilitation contract (GSC). This GSC is a moral contract where the physician or therapist identifies specific muscles, particularly hypo-extensible and disabling that act as antagonists to functional activities. The physician or therapist then teaches and prescribes quantified daily high-load self-stretch postures for these muscles, alternating with repeated maximal amplitude movement exercises against their resistance. In turn, the patient commits to practicing the prescribed program and to delivering a diary of the stretch postures and alternating movement exercises performed each day. Over 4 years of GSC, the patient practiced upon prescription against a total of seven upper limb antagonists to common functional movements: shoulder extensors, shoulder internal rotators, elbow flexors, elbow pronators, wrist and finger flexors, and interossei muscles. She manually filled up her diary 99% of the days. Each day, she practiced an average of 20 min of high-load static self-stretch per muscle, alternating with about 50 maximal active efforts against the resistance of each targeted muscle's resistance. Overall, her mean static self-stretch time was 81 ± 2 (mean ± SEM) min/day, and her mean number of active maximal efforts was 285 ± 78/day, for a total daily self-rehabilitation time of over 2 h a day. Five years after her stroke, she had recovered all left upper extremity use in daily activities and resumed her previous job as a nurse's aide. She now spontaneously uses her left hand in most tasks. Functional MRI (March 2020) demonstrated bilateral primary motor and motor supplementary area activation upon left-hand exercise. Prolonged static self-stretch increased muscle extensibility (muscle plasticity) while maximal amplitude, alternating movement training reduced co-contraction in these muscles (neural plasticity). The Modified Frenchay Scale assessment was video-recorded by the clinician at each visit, allowing qualitative and quantitative evaluation of the functional capacities. The two videos of the first and last clinic visits have been uploaded and are available.
10.3389/fresc.2024.1385483
Differences in Daily Activity Performance Between Inpatient Rehabilitation Facility and Home Among Stroke Survivors.
Neurorehabilitation and neural repair
BACKGROUND:Stroke survivors are one of the largest consumer groups of rehabilitation services. Despite improvement in daily activities while in inpatient rehabilitation, many have difficulty performing daily activities at home after discharge. The difference in performance between a standard clinical context and at home is poorly understood. OBJECTIVE:To better understand differences in activity performance during transition from inpatient rehabilitation facility (IRF) to home, we examined daily activity performance scores from 2 different environments (IRF and home) at the same time point (discharge). METHODS:This was a cross-sectional analysis using baseline data from a randomized controlled trial. Participants were stroke survivors aged ≥50 who planned to discharge home from the IRF. The Functional Independence Measure and Section GG codes (both converted to International Classification of Functioning, Disability, and Health scores) were conducted per protocol first at home and then in the IRF at discharge (≤3 days apart, order not randomized). RESULTS:Among 57 participants, activity scores at home were significantly worse than scores at IRF discharge. Over 40% of participants had discharge scores indicating no-to-mild impairment for shower/tub transfer, walking, and going up/down stairs, while home visit scores indicated moderate-to-complete impairment for those activities. The greatest differences in scores were for shower/tub transfer (median difference 1.5, 95% CI 1.00-2.00) and going up/down stairs (median difference 1.50, 95% CI 1.00-2.00). CONCLUSION:The environment plays an important role in stroke survivors' functioning at home. Future studies should further examine how the environment impacts activity performance upon returning home following stroke.
10.1177/15459683241246266
The impact of post-stroke fatigue on inpatient rehabilitation outcomes: An observational study.
PloS one
BACKGROUND:Post-stroke fatigue is a typical complication following stroke. However, existing research primarily focused on its underlying mechanisms, and its impact on rehabilitation outcomes has yet to be uncovered. OBJECTIVE:This study aims to explore the impact of post-stroke fatigue on rehabilitation outcomes during hospitalization. METHOD:This was a prospective multicenter observational study including 46 stroke patients receiving comprehensive rehabilitation treatment. Patients' basic information was recorded upon admission and patients' functional independence was assessed with Functional Independence Measure (FIM) both upon admission and discharge. One week after rehabilitation treatment, fatigue, positivity in daily activity, attention, and memory were assessed. Serum biochemical indicators and levels of C-reactive protein (CRP) were assessed weekly following admission. The pain scores were assessed during the first week of hospitalization to calculate the average. Correlation analysis, linear regression and propensity score matching (PSM) were used to analyze the impact of fatigue on FIM scores at discharge and length of hospital stay. RESULT:The proportion of patients with low fatigue was 39.13% and significant improvement was revealed in FIM scores upon admissions and discharge [(50.67±18.61) vs. (75.13±21.04), P<0.05]. Positivity in daily activity, attention, and age are factors that influence post-stroke fatigue. After PSM, low-fatigue group (Fatigue score< 3) showed significant higher motor function independence at discharge [(54.39 ± 15.42) vs. (41.89 ± 14.90), P<0.05] and shorter hospital stay [(28.54±9.13)d vs. (37.32 ± 9.81)d, P<0.05] than high-fatigue group. There was a significant difference (P<0.05) in level of CRP between the first inpatient week and the third week, with declining trend. CONCLUSION:Post-stroke fatigue can affect the rehabilitation outcomes regarding motor function independence and length of hospital stay.
10.1371/journal.pone.0302574
Process mining and customer journey mapping in healthcare: Enhancing patient-centred care in stroke rehabilitation.
Digital health
Background:Patient-centred care and enhancing patient experience is a priority across Australia. Stroke rehabilitation has multiple consumer touchpoints that would benefit from a better understanding of customer journeys, subsequently impacting better patient-centred care, and contributing to process improvements and better patient outcomes. Customer journey mapping through process mining extracts process data from event logs in existing information systems discovering patient journeys, which can be utilized to monitor guideline compliance and uncover nonconformance. Methodology:Utilizing process mining and variant analysis, customer journey maps were developed for 130 stroke rehabilitation patients from referral to discharge. In total, 168 cases from the Australasian Rehabilitation Outcomes Centre dataset were matched with 6291 cases from inpatient stroke data. Variants were explored for age, gender, outcome measures, length of stay and functional independence measure (FIM) change. Results:The study illustrated the process, process variants and patient journey map in stroke rehabilitation. Process characteristics of stroke rehabilitation patients were extracted and represented utilizing process mining and results highlighted process variation, attributes, touchpoints and timestamps across stroke rehabilitation patient journeys categorized by patient demographics and outcome variables. Patients demonstrated a mean and median duration of 49.5 days and 44 days, respectively, across the patient journeys. Nine variants were discovered, with 78.46% ( = 102) of patients following the expected sequence of activities in their stroke rehabilitation patient journey. Relationships involving age, gender, length of stay and FIM change along the patient journeys were evident, with four cases experiencing stroke rehabilitation journeys of more than 100 days, warranting further investigation. Conclusion:Process mining can be utilized to visualize and analyse patient journeys and identify gaps in service quality, thus contributing to better patient-centred care and improved patient outcomes and experiences in stroke rehabilitation.
10.1177/20552076241249264
Utilization of early supported discharge and outpatient rehabilitation services following inpatient stroke rehabilitation.
Archives of public health = Archives belges de sante publique
BACKGROUND:Studies examining factors associated with patient referral to early supported discharge (ESD)/outpatient rehabilitation (OPR) programs and utilization of ESD/OPR services after discharge from inpatient stroke rehabilitation (IPR) are scarce. Accordingly, we examined utilization of ESD/OPR services following discharge from IPR and patient factors associated with service utilization. METHODS:Stroke patients discharged from IPR facilities in Alberta between April 2014 and March 2016 were included and followed for one year for ESD/OPR service utilization. Multivariable linear and negative binomial regressions were used to examine association of patients' factors with ESD/OPR use. RESULTS:We included 752 patients (34.4% of 2,187 patients discharged from IPR) who had 40,772 ESD/OPR visits during one year of follow-up in the analysis. Mean and median ESD/OPR visits were 54.2 and 36 visits, respectively. Unadjusted ESD/OPR visits were lower in females and patients aged ≥ 60 years but were similar between urban and rural areas. After adjustment for patient factors, patients in urban areas and discharged home after IPR were associated with 83.5% and 61.9%, respectively, increase in ESD/OPR visits, while having a right-body stroke was associated with 23.5% increase. Older patients used ESD/OPR less than their younger counterparts (1.4% decrease per one year of older age). Available factors explained 12.3% of variation in ESD/OPR use. CONCLUSION:ESD/OPR utilization after IPR in Alberta was low and varied across age and geographic locations. Factors associated with use of ESD/OPR were identified but they could not fully explain variation of ESD/OPR use.
10.1186/s13690-024-01300-w
Prediction of long-term functional outcome following different rehabilitation pathways after stroke unit discharge.
Journal of rehabilitation medicine
OBJECTIVE:To investigate whether referral for different types of rehabilitation on discharge from Swedish stroke units can predict functional outcomes at 1 and 5 years after a stroke. DESIGN:A longitudinal and registry-based study. SUBJECTS/PATIENTS:A total of 5,118 participants with index stroke in 2011 were followed-up at 1 and 5 years after the stroke. METHODS:Ordinal logistic regression models were developed to predict the category of functional outcome: independent, dependent, or dead. The primary predictors were planned rehabilitation in a home setting, inpatient rehabilitation, and outpatient rehabilitation, with no planned rehabilitation as the reference category. RESULTS:Planned outpatient rehabilitation predicted independence (compared with death) at 1 year. Planned rehabilitation in the home setting predicted independence (compared with death) at 1 and 5 years. Compared with other planned pathways, participants planned for inpatient rehabilitation had more severe conditions, and planned inpatient rehabilitation did not predict independence. CONCLUSION:Planning for outpatient or home-based rehabilitation appeared to lead more effectively to participants achieving independence over the course of 1-5 years. This may have been due to the less severe nature of these participants' conditions, compared with those requiring inpatient rehabilitation.
10.2340/jrm.v56.19458