Abstract WP385: The Stroke Transitions Education and Prevention Clinic: a Comprehensive Approach to Post-stroke Care
Background: Aging of the population is expected to lead to increased numbers of stroke survivors in the US. However, there are no organized outpatient systems of care dedicated to risk factor and complication management of stroke survivors in the U.S.
Purpose: We sought to establish a stroke prevention clinic wherein a comprehensive approach to the management of discharged stroke patients would be implemented by a physician and nurse practitioner (NP).
Methods: We obtained input from multiple stake-holders including physicians and mid-level providers, hospital and clinic administrators, social work, and stroke survivors and caregivers. Our conceptual framework for effective post-stroke care incorporated stakeholder input, evidence-based guidelines, and critical appraisals of literature related to risk factor modification and stroke recovery. Together with the stroke NP, we developed protocols for risk factor and complication assessment and management, created educational materials at appropriate literacy levels, and trained clinic staff in administration of Patient Health Questionnaire 9 (PHQ-9, depression), Epworth sleepiness scale (ESS, sleep apnea), and Morisky medication adherence scale (MedAd).
Results: We began the pilot phase of the Stroke Transitions Education and Prevention (STEP) Clinic on June 16, 2014 and established the clinic registry in October 2014. From June 16 , 2014 to July 15, 2015, 222 patients were evaluated in the clinic by the stroke NP or MD. Median time to follow-up was 41 days (IQR 32, 56). The population was 45.5% female, 59% racial/ethnic minority, and median age was 62 (SD 13.8). Among patients with ischemic (70.7%) and hemorrhagic (21.2%) stroke, initial clinic blood pressure was controlled for 67.5% and 72.3%, respectively. PHQ-9, ESS, and MedAd were complete for 92.7%, 89%, and 86.5% of participants, respectively.
Conclusions: The STEP clinic was developed and implemented to facilitate provision of comprehensive care to stroke survivors. Post-stroke clinics may aid in improving risk factor control and quality of life after stroke. Patient co-management with NPs can increase institutional capacity for providing post-stroke care.
Author Disclosures: A. Sharrief: Research Grant; Modest; KL2 to study STEP clinic. M.N. Okpala: None. K. Vu: None. S.I. Savitz: None.
- © 2016 by American Heart Association, Inc.