Call for Navigation: Charting a Course for Stroke Survivors

This Stroke Navigator Program is just rearranging the deck chairs on the Titanic. If you are going to address the upcoming tsunami of stroke you need to solve all the problems in stroke. This is just a fucking bandaid on a gaping hole in the brain.
http://www.cardiovascularbusiness.com/topics/practice-management/call-navigation-charting-course-stroke-survivors?page=0%2C0

Approximately 130,000 Americans will die from stroke this year. Another 795,000 people will suffer a stroke and live to join the 6.5 million stroke survivors in the United States today. Many will struggle with long-term disability, isolation and confusion. Nearly two-thirds of Medicare beneficiaries discharged after an ischemic stroke die or are rehospitalized within one year (Stroke 2011;42[1]:159-66). In the United States, the cost of stroke—including healthcare services, medications and lost productivity—totals $34 billion annually (Circulation 2015;131:e29-e322). 
Today’s stroke statistics are a drop in the bucket compared with the “stroke tsunami” that the National Stroke Association (NSA) says will accompany the aging of the baby boomers. By 2030, the prevalence of stroke will increase by 3.4 million people relative to 2012 and direct medical stroke-related costs will triple, according to American Heart Association/American Stroke Association projections (Stroke 2013;44:2361-2375). Improving how stroke survivors reintegrate into their communities and access resources needs to be a priority, says Amy Nieberlein, MSN, ACNP-BC, FNP-C, CEN. She talked with Cardiovascular Business about the NSA Stroke Recovery Navigator Program she’s helping to pilot at Swedish Medical Center in Denver.

What is the goal of the Stroke Recovery Navigator Program?

Put simply, the goal is make sure patients are equipped to handle life as stroke survivors. That means helping patients and their caregivers access resources that will improve their health outcomes and quality of life after they leave the hospital.

How did the pilot program work at your hospital?

During rounds, the other nurses and I told the patients about the program. The patients who agreed to participate were assigned to an NSA navigator who performed an initial needs assessment for each participant and identified community resources that matched his or her needs. The navigator worked with them for up to six months after hospital discharge.

What did the navigators do?

The navigators mostly provided telephone support to the stroke patients and their caregivers. Depending on the resources available and each patient’s needs, they might help with medication questions, address transportation barriers, make connections with stroke support groups and help them tackle the challenges associated with returning to work or activities of daily living. They also reinforced the education that we convey to all stroke patients when they’re discharged, including risk factor management and why it’s critical to seek immediate medical attention for stroke symptoms.

How was success measured?

The NSA set goals for several metrics for success, such as better than the national average for rehospitalization and improved scores on indexes for normal living reintegration (for patients) and reduced burden (for caregivers). For the most part, the program exceeded NSA’s goals for phase 1 (see Figure).
As a pilot site, we didn’t get to see the metrics for our group of patients specifically—we will in phase 2, which will be helpful—but I feel sure our patient satisfaction metrics would be up for the patients in this program, because it makes them feel empowered.

Based on your experience with patient care, what is the key to success for transition-to-home programs like this one?

The navigators start where the patient is. Where the process begins and how it moves forward are both highly individualized. There’s no way our hospital, which is a telemedicine hub serving eight states, could provide that kind of service to all of our patients, but trained navigators can get to know the patients and the resources their communities offer, and then match them. 

How did participating in the program affect your daily work?

Swedish Medical Center was one of three hospitals that participated in phase 1 of the pilot. Before patients were discharged from the acute care setting, we invited them to join the program. If they were interested, we sent their information to the NSA navigator assigned to our hospital. It didn’t add much work for us, and there were no costs for us to participate.

Based on your experience, which patients would you expect to benefit from a navigator program like this one?

You get to know your patients and get a sense for which ones will be engaged in their care. Patients with engaged family members seemed more likely to join the program, but I actually think the program would be even more valuable

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Stroke Recovery Navigator

You can try to guess what this involves from this press release. Notice the only workable links are for donations. They really don't give a shit about survivors except as money sources. Totally worthless even as a press release.
https://www.stroke.org/news-release/dramatic-results-seen-pilot-stroke-recovery-navigator-program

Dear dean,

The first days at home after a stroke are confusing and overwhelming. With your support, we offer real help.

By making a gift today, you create meaningful impact in the lives of stroke survivors and their vital circle of care. And, because of our matching gift challenge, your gift will go twice as far to meet the critical needs that stroke survivors face.

Through programs such as our Stroke Recovery Navigator^sm survivors and caregivers partner with a trained Patient Navigator for up to six months after discharge from the hospital. Given that each survivor’s recovery journey is unique, it is vital that that the Navigator and survivor co-create a plan to identify and overcome barriers, attain self-advocacy skills, and access support and resources. Our groundbreaking program empowers survivors to take control of their recovery. With the support of this program:

• 4% of stroke survivors were readmitted to the hospital due to stroke, compared to a recent study average of 15%
• 99% of stroke survivors reported an increased ability to resume the activities they previously engaged in socially and within their community
• 94% of caregivers reported a decrease in the burden created when they stepped into the caregiving role

Will you make a gift today to support this important work? Don’t forget – through the generosity of an anonymous donor, your donation will be doubled to make twice the impact for our stroke community. In order for this program and our other life-saving initiatives to move forward, we need your gifts. Thank you for your support.

Warm Regards,

Jamie Charbonneau
Vice President, Development

Dramatic Results Seen in Pilot Stroke Recovery Navigator(SM) Program

So once again after the fact interventions are proposed and set up, rather than actually preventing lots of these problems in the first place by stopping the neuronal cascade of death. Are there any functioning neurons anywhere in the National Stroke Association?
http://www.reuters.com/article/idUSnMKWfJ9VHa+1d6+MKW20160218
(Marketwired - Feb 18, 2016) - National Stroke Association released today the promising results from the pilot of its Stroke Recovery Navigator(SM) program (SRN) at the International Stroke Conference in Los Angeles. The results underscore the value and impact of human connections, personal guidance and support in stroke recovery, to survivors and caregivers alike.
In 2014, National Stroke Association launched the pilot program to examine the use of community-based patient navigation with stroke survivors and their caregivers. The SRN program was designed as a telephone-based navigation program to engage survivors and/or their caregivers from two to six months post-discharge after a stroke. The results were dramatic:

• Re-hospitalizations dropped to 13% from 49%, the national average for all-cause re-hospitalization.
• 90% of participants (92% of survivors, 88% of caregivers) reported that the stroke survivor was taking medications exactly as directed.
• 95% of participants found the SRN program to be a valuable service. 
• 85% reported that the program made them feel better equipped to make decisions about their health.

"Stroke Recovery Navigator is the only patient navigator program of its kind in the United States," said Julia Richards, Survival Programs Manager at National Stroke Association. "We expected positive outcomes from this pilot, but we were really amazed at how dramatic the benefits were all around -- from the stroke survivors, to the caregivers, to even the hospitals. We're excited to share these promising findings with the larger stroke community."
A stroke leaves survivors and their caregivers without time to prepare for life after stroke. For the 795,000 people who will survive a stroke this year, the return home can mean long-term disability, isolation, confusion and for nearly half, re-hospitalization. For caregivers, the added responsibility can be overwhelming and often leads to dangerous increases in stress and anxiety.
Stroke Recovery Navigator Pilot Program: Subjects and Methods
National Stroke Association initiated a pilot of the Stroke Recovery Navigator program with the goal of reintegrating clients into their community and measuring the impact of patient navigation in the stroke community. A voice of hope for stroke survivors, SRN's telephone support engaged survivors and caregivers, providing help with medication management, overcoming barriers, confronting relationship problems, identifying community services for such needs as transportation, and general adaptations to daily living.
During the six-month pilot program, 89 participants were included in the SRN program. Referred survivors or caregivers were contacted within three to five days, and weekly thereafter.
The program addressed the following topics:

• barriers to care
• adjusting to deficits from stroke
• connection with Stroke Support Groups
• unexpected consequences of post-stroke recovery
• prevention of secondary stroke
• management of stroke risk factors
• community resources to address challenges experienced by the survivor or caregiver
• management of post-stroke conditions
• return to work, and
• emotional support for adjustment to community living.
• (Nothing on rehabilitation protocols to get to 100% recovery)  

At enrollment, participants were provided with a recovery packet of information from National Stroke Association, including Hope: A Stroke Recovery Guide, as well as tools for managing stroke risk factors.
Participants reported that they valued the relationship with their Navigator and appreciated the information given to them. As stroke survivors moved through the navigation program, they reported a greater confidence in their ability to manage daily activities and assessed themselves as better able to engage with their community.
Additionally, Navigators noted that caregivers reported more satisfaction with their stroke survivors' adjustment, leading to a reduction in their perception of the burden of care. Participating hospitals also reported satisfaction with the program. They indicated a desire to have a closer relationship with the Navigators and to get specific feedback regarding patient participation and satisfaction with the program.
"These results clearly point to the benefit of navigation services in the stroke disease state," added Richards. "Post-discharge support is imperative to recovery. This pilot program provides important validation that more should be done in this arena to service to the stroke community."

Stroke is scary. We can help - Latest NSA email

It's scary because your doctor is doing nothing in the first week to stop the neuronal cascade of death. And if they were being truthful they would tell you how screwed you are.
http://support.stroke.org/site/R?i=zllrUHS1RiyrlpO5LO1__Q
This page doesn't even point to the Stroke Recovery Navigator^sm 

program, whatever it is. Come on, Mr. Lopez you can do better than that, you're a stroke survivor yourself, doesn't anyone vet the communications you send out? Or run it by a survivor? Survivors are confused, this does nothing to help them. Seaching for the term finds nothing.  Sent this exact reply back to Mr. Lopez, we'll see if he responds. Someone has to point out how useless the NSA is.