Abstract
BackgroundOutpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke.MethodsPatients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models.ResultsIn total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality.ConclusionThis study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care.Trial registrationDRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019).
Highlights
Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves
There were no significant differences between the two intervention groups regarding age, sex, degree of care dependency before the stroke, or stroke type
Our study investigated the potential effects of a coordinated care program for community-based stroke survivors within 12 months after their initial stroke
Summary
Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. Due to improved acute care and prevention strategies, mortality and age-adjusted incidence have been decreasing in high-income countries over the last decades. The absolute numbers of stroke events in aging populations are still increasing. Patients are at a high risk of having recurrent strokes and need regular screening and risk factor treatment [4]
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