Improving stroke transitions: Development and implementation of a social work case management intervention

被引:23
作者
Hughes, Anne K. [1 ]
Woodward, Amanda T. [1 ]
Fritz, Michele C. [2 ]
Reeves, Mathew J. [2 ]
机构
[1] Michigan State Univ, Sch Social Work, E Lansing, MI 48824 USA
[2] Michigan State Univ, Dept Epidemiol & Biostat, E Lansing, MI 48824 USA
关键词
Case management; care transitions; patient-centered; randomized controlled trial; stroke; HOSPITAL READMISSION; OLDER-ADULTS; CARE; DISCHARGE; TRIAL; MODEL;
D O I
10.1080/00981389.2017.1401027
中图分类号
C916 [社会工作、社会管理、社会规划];
学科分类号
1204 ;
摘要
Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.
引用
收藏
页码:95 / 108
页数:14
相关论文
共 29 条
[1]   Effects of an Enhanced Discharge Planning Intervention for Hospitalized Older Adults: A Randomized Trial [J].
Altfeld, Susan J. ;
Shier, Gayle E. ;
Rooney, Madeleine ;
Johnson, Tricia J. ;
Golden, Robyn L. ;
Karavolos, Kelly ;
Avery, Elizabeth ;
Nandi, Vijay ;
Perry, Anthony J. .
GERONTOLOGIST, 2013, 53 (03) :430-440
[2]   The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care [J].
Alvarez, Renae ;
Ginsburg, Jacob ;
Grabowski, Jessica ;
Post, Sharon ;
Rosenberg, Walter .
JOURNAL OF GERONTOLOGICAL SOCIAL WORK, 2016, 59 (03) :222-227
[3]   Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale [J].
Bakas, Tamilyn ;
Champion, Victoria ;
Perkins, Susan M. ;
Farran, Carol J. ;
Williams, Linda S. .
NURSING RESEARCH, 2006, 55 (05) :346-355
[4]   Transitional Care After Hospitalization for Acute Stroke or Myocardial Infarction A Systematic Review [J].
Bettger, Janet Prvu ;
Alexander, Karen P. ;
Dolor, Rowena J. ;
Olson, DaiWai M. ;
Kendrick, Amy S. ;
Wing, Liz ;
Coeytaux, Remy R. ;
Graffagnino, Carmelo ;
Duncan, Pamela W. .
ANNALS OF INTERNAL MEDICINE, 2012, 157 (06) :407-U61
[5]   Development and validation of the stroke action test [J].
Billings-Gagliardi, S ;
Mazor, KM .
STROKE, 2005, 36 (05) :1035-1039
[6]   Analysis of a Social Work-Based Model of Transitional Care to Reduce Hospital Readmissions: Preliminary Data [J].
Boutwell, Amy E. ;
Johnson, Marian B. ;
Watkins, Ralph .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2016, 64 (05) :1104-1107
[7]  
Braun V., 2006, QUAL RES PSYCHOL, V3, P77, DOI [10.1191/1478088706qp063oa, DOI 10.1191/1478088706QP063OA]
[8]   Impact of a Social Work Care Coordination Intervention on Hospital Readmission: A Randomized Controlled Trial [J].
Bronstein, Laura R. ;
Gould, Paul ;
Berkowitz, Shawn A. ;
James, Gary D. ;
Marks, Kris .
SOCIAL WORK, 2015, 60 (03) :248-255
[9]   NIH's transformative opportunities for the behavioral and social sciences [J].
Collins, Francis S. ;
Riley, William T. .
Science Translational Medicine, 2016, 8 (366)
[10]   Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis [J].
Ellis, Graham ;
Mant, Jonathan ;
Langhorne, Peter ;
Dennis, Martin ;
Winner, Simon .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2010, (05)