Age and Ageing Advance Access originally published online on November 14, 2007
Age and Ageing 2008 37(1):32-38; doi:10.1093/ageing/afm133
Bridging the gap: the effectiveness of teaming a stroke coordinator with patient's personal physician on the outcome of stroke
1 Division of Clinical Epidemiology, McGill University Hospital Centre, Montreal, Quebec, Canada
2 Clinical and Health Informatics Research Unit, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
3 University of Texas Health Science Centre, San Antonio, Texas, USA
4 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
5 Division of Geriatrics, McGill University Health Center, Montreal, Quebec, Canada
6 St. Mary's Hospital Centre, Montreal, Canada
7 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
Address correspondence to: Nancy E. Mayo. Tel: (514) 934 1934 36922, Fax: (514) 843 1493. Email: nancy.mayo{at}mcgill.ca
Objectives: to test the hypothesis as to whether persons newly discharged into the community following an acute stroke and assigned a stroke case manager would experience, compared to usual post-hospital care, better health-related quality of life (HRQL), fewer emergency room visits and less non-elective hospitalisations.
Design: a stratified, balanced, evaluator-blinded, randomised clinical trial.
Setting: five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.
Participants: persons (n = 190) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health care supervision post-discharge because of low function, co-morbidity, or isolation.
Intervention: for 6 weeks following hospital discharge a nurse stroke care manager maintained contact with patients through home visits and telephone calls designed to coordinate care with the person's personal physician and link the stroke survivor into community-based stroke services.
Measurements: the primary outcome was the Physical Component Summary (PCS) of the Short-Form (SF)-36 survey. A secondary outcome was utilisation of health services. Also measured was the impact of stroke on functioning. Measurements were made at hospital discharge (baseline), following the 6-week intervention and at 6-months post-stroke.
Results: the average age of the participants was 70 years. Discharge was achieved on average 12 days post-stroke and most participants had had a stroke of moderate severity. There were no differences between groups on the primary outcome measure, health services utilisation, or any of the secondary outcome measures.
Conclusion: for this population, there was no evidence that this type of passive case management inferred any added benefit in terms of improvement in health-related quality of life or reduction in health services utilisation and stroke impact, than usual post-discharge management.
Keywords: stroke, case management, health services research, quality of life, co-morbidity, elderly
Received 27 November 2007; accepted in revised form 25 May 2007.