Stroke Self-Management: Effect on Function and Stroke Quality of Life

中风自我管理：对功能和中风生活质量的影响

• 批准号: 9077057
• 负责人: TERESA M. DAMUSH
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2016-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9077057
• 关键词: Accident and Emergency department; Acute; Address; Affect; Age; Ambulatory Care; Behavior; Blood Vessels; Caregivers; Caring; Case Manager; Cessation of life; Chronic; Chronic Disease; Clinic; Clinical; Coagulation Process; Data; Department of Defense; Development; Diabetes Mellitus; Disease; Elements; Evaluation; Event; Evidence based program; Family; Focus Groups; Future; Goals; Guidelines; Health; Healthcare; Healthcare Systems; Home environment; Hypertension; Intervention; Ischemic Stroke; Joints; Learning; Manuals; Medical; Methods; Morbidity - disease rate; Neurologic; Outpatients; Participant; Patient Care; Patients; Performance; Pilot Projects; Population; Prevention; Process; Provider; Psychologist; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Reporting; Research; Residual state; Risk; Risk Factors; Risk Management; Role; Self Efficacy; Self Management; Services; Social Work; Social isolation; Stroke; Stroke Volume; Stroke prevention; Structure; Suggestion; Survivors; Taxes; Telephone; Testing; Transient Ischemic Attack; Universities; Variant; Veterans; Work; Writing; base; behavioral health; clinical care; coping; cost; design; disability; evidence base; group support; health related quality of life; improved; loss of function; medical specialties; mortality; patient home care; point of care; post stroke; post stroke depression; prevent; primary outcome; programs; randomized trial; secondary outcome; telehealth; tool; treatment as usual; trend; trial comparing

DESCRIPTION (provided by applicant): Anticipated Impacts on Participant's Healthcare: This planned evaluation of our stroke self- management program may improve the patient's healthcare by establishing an evidence-based program for which VA case managers may implement to improve patient self-management and the health-related quality of life of stroke survivors. This program will produce standardized manuals for case managers and stroke survivors that may be used in the field, in the patient medical care home and via telehealth. Project Background: Stroke is prevalent and associated with increased morbidity and mortality. Stroke is the leading cause of long-term disability in the US. Within the VA, approximately 60,000 patients had a primary outpatient encounter for stroke during fiscal year 2010 (FY10). Data from the Office of Quality and Performance (OQP) Stroke Special Study demonstrate that more than 5,000 veterans were admitted to a VA facility for acute ischemic stroke in FY07 and another 5000 veterans with a transient ischemic attack (TIA) or mini-stroke, were admitted in a VA facility or received care at an urgent clinic or emergency department in VA. The total VA cost of stroke treatment was almost $315 million in FY05, with a cost per patient of over $18,000. Stroke/TIA survivors are at elevated risk for future vascular events and yet, there are no systematic post stroke programs offered widely in VA designed to reduce this risk and increase stroke specific quality of life in veterans. We recently developed and pilot tested a stroke self-management program that adapted the Stanford Chronic Disease program for stroke. Project Objectives: The objectives of this project are to: 1. Conduct a randomized trial comparing stroke survivors randomly assigned to receive a stroke self-management program on patient functioning, stroke self-management, and stroke specific quality of life compared to stroke survivors assigned to usual care; and 2. Conduct a summative evaluation among VA clinical providers, patients with stroke and their caregivers to understand the barriers and facilitators of implementing the stroke self-management program. Project Methods: To accomplish these aims, we will employ mixed methods. For the first aim, we will conduct a randomized controlled trial comparing subjects randomly assigned to the stroke self-management intervention to subjects randomly assigned to usual care. Subjects from both groups will be assessed at baseline, 3, 6, and 12 months. The stroke self-management program will be delivered over 6 months (12 weeks biweekly sessions followed by 12 weeks of bimonthly telephone and group support sessions). Usual care participants will receive written stroke risk factor materials. Our primary outcomes will be stroke specific quality of life and our secondary outcomes will be stroke self-management, self-efficacy, functioning, and post stroke depression. For the second aim, we will hold focus groups with participants and their caregivers to best understand their barriers to participation and suggestions for future implementation.

描述（由申请人提供）： 对参与者的医疗保健的预期影响：对我们的中风自我管理计划的计划评估可以通过建立基于证据的计划来改善患者的医疗保健，以改善中风幸存者的患者自我管理和与健康相关的生活质量，以改善患者的医疗保健。 该计划将为案例经理和中风幸存者制作标准化的手册，这些手册可能在该领域，患者医疗馆和通过远程医疗中使用。 项目背景：中风很普遍，与发病率和死亡率的增加有关。 中风是长期残疾的主要原因 我们。 在VA内，2010财政年度大约有60,000名患者在2010财政年度（FY10）中遭受了中风的主要遭遇。 质量与绩效办公室（OQP）中风办公室的数据特别研究表明，在07财年，有5,000多名退伍军人被接纳为急性缺血性中风的VA设施，另外5000名退伍军人在紧迫的或紧急的企业中接受了VA机构或接收到的VA机构，并接受了短暂性缺血性攻击（TIA）或小型冲突。 在05财年，中风治疗的总VA成本接近3.15亿美元，每位患者的成本超过18,000美元。 中风/TIA幸存者对未来的血管事件的风险较高，但是，在VA中尚无系统性的中风计划，旨在降低这种风险并增加退伍军人的中风特定的生活质量。 我们最近开发并试点测试了一项中风自我管理计划，该计划适应了斯坦福慢性疾病计划的中风计划。 项目目标：该项目的目标是：1。进行随机分配的中风幸存者的随机试验，以接受有关患者功能，中风自我管理和中风特定生活质量的中风自我管理计划，与分配给常规护理的中风幸存者相比；和2。对VA临床提供者，中风患者及其护理人员进行总结性评估，以了解实施中风自我管理计划的障碍和促进者。 项目方法：为了实现这些目标，我们将采用混合方法。 为了第一个目标，我们将进行一项随机对照试验，将随机分配给中风自我管理干预的受试者与随机分配给常规护理的受试者进行比较。 两组的受试者将在基线，3、6和12个月进行评估。 中风的自我管理计划将在6个月内进行（每两周工作12周，然后进行12周的每两个月电话和小组支持会议）。 通常的护理参与者将获得书面中风风险因素材料。 我们的主要结果将是中风特定的生活质量和我们的 次要结果将是中风的自我管理，自我效能感，功能和中风后抑郁症。 为了第二个目标，我们将与参与者及其护理人员保持焦点小组，以最好地了解他们的参与障碍和未来实施的建议。