Vanderbilt's Kenneth Gaines, MD, MBA, professor of Clinical Neurology, has received a $15.7 funding award to determine if stroke outcomes can be improved with a redesigned and better-integrated model of care.
The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors approved the study led by Gaines.
Gaines will work closely with co-investigator Barry Jackson, a stroke survivor with a nonclinical background, in supervising the study, which will be conducted at 18 clinical sites across the nation.
The study was designed with input from stroke survivors and their caregivers. It follows research that Gaines has conducted since the 1990s that began with home-based visits and has evolved into telehealth initiatives. But the redesigned model of care in the PCORI study involves much more than that. It's an integrated practice unit redesign that emphasizes team-based care in hospitals, enhanced collaboration with rehabilitation centers and one year of follow-up care delivered where patients live.
"That post-acute phase year is what I call the neglected year," Gaines said. "There is high mortality. There is a high recurrence rate for stroke. There is a high risk for heart attack. There is a high risk for secondary complications like clots in the leg, pneumonias and urinary tract infections. There is a pretty high disability and depression rate. And there is a very high caregiver strain associated with that period of time."
In the study, the clinical sites will be randomized to either continue standard comprehensive/primary stroke care or be re-engineered to an integrated stroke practice unit model. The two arms of the study will be compared for length of hospital stay, readmissions, recurrence rates and cost.
The new model calls for the addition of a stroke central nurse at hospitals, who will function as the routing person for patients and will be responsible for quality of care checklists. Each hospital will have an advisory committee of stroke patients and their caregivers.
The focus will be on continuity of care from the minute a stroke patient comes into a hospital emergency room until a year after they leave the hospital.
"Patients sort of fall of the cliff, if you will, in terms of having a support system," Gaines said.
Once patients return home, they will be followed up with monthly visits from a registered nurse and a lay educator through a program called Stroke Mobile.
"That sounds like a lot of contact, but that's 29 days out of the month where you are not making contact," Gaines said. "We wanted to build some technology components to help us fill in the gap."
Patients will use telehealth technology to report daily blood pressure readings to a Vivify Health disease management platform that quickly identifies patients who require attention. There is also a telehealth component with the monthly visits.
"If the home-based team goes out and has a question about medication, there is a pharmacist virtually available to work with them on the spot. If they have a question about rehabilitation, there is a physical therapist or speech therapist who can help with that. If they have a vascular neurology question, then somebody like myself is available."
The $15.7 million award, which will cover a four-year period, is pending contract approval after completion of a business and programmatic review by PCORI staff.
PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.
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