Deans' stroke musings: Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, September 2, 2017

Improving discharge care: The potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study

Who gives a fuck about discharge care? When you are discharged with 100% recovery you really need nothing else. Solve the correct problem you blithering idiots, 100% recovery. Are you not up to the challenge of the BHAG(Big Hairy Audacious Goal) of 100% recovery?
https://www.mdlinx.com/internal-medicine/medical-news-article/2017/08/25/discharge-care-acute-stroke-intervention-tia/7281677/?

BMJ Open

Cadilhac DA, et al.

In order to improve the discharge care in patients admitted with acute stroke or transient ischaemic attack, this study intended to formulate and pilot test an interdisciplinary, organisational intervention. An effective and sustained improvement could be attained via a staged and peer–informed, organisational intervention. Additional application and research on a larger scale were necessitated.

Methods

This research was performed at the acute care public hospitals in Queensland, Australia (n=15).
15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes.
The participants took part in a focus group to elicit their success factors.
Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers.
The enrollment constituted hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack.
A four-stage, multifaceted organisational intervention involved data reviews, education and facilitated action planning.
The primary measures were 3 discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only).
Primary measure was the composite outcome.
Secondary measures included individual adherence changes for each discharge process; sensitivity analyses.
A comparison was carried out of the performance outcomes , 3 months prior to the intervention (preintervention), 3 months postintervention and at 12 months (sustainability).

Results

An inspection was conducted of the findings from 1289 episodes of care from the two pilot hospitals.
Improvements from preintervention adherence were: Antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001).
An insignificant decay effect was reported over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08).