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.
Stroke affects at least 17,000 veterans each year and this number will likely increase as the veteran population ages. Our previous QUERI work indicates that stroke risk factors are often undermanaged by VHA. Our proposed study provides VHA with an evidence-based tool for implementing VA/DoD guidelines on secondary stroke prevention. Moreover, the proposed project will evaluate the program in 3 facilities with small, medium and large volume of stroke patients that will enable us to plan the tailoring of the program to accommodate the structure of VA neurological services across VHA. Furthermore, as VHA sets up its Patient Care Medical Home Labs with a focus on patient self-management and behavioral health, our stroke self- management program offers a standardized program with support materials for health psychologists and care managers to use for stroke survivors in outpatient care.
| Chen, Chen X; Kroenke, Kurt; Stump, Timothy E et al. (2018) Estimating minimally important differences for the PROMIS pain interference scales: results from 3 randomized clinical trials. Pain 159:775-782 |
