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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Updated guidelines recommend team approach and rehab programs following strokes

What a fucking waste, they have already passed the first week of the neuronal cascade of death, and just discussing where to do therapy that has a 10% chance of getting them to full recovery. You fucking idiots, Solve the correct problem, don't just rearrange the deck chairs on the Titanic
http://www.cardiovascularbusiness.com/topics/vascular-endovascular/updated-guidelines-recommend-team-approach-and-rehab-programs-following-strokes
May 17, 2016 | Tim Casey

After patients suffer a stroke, their rehabilitation program should include input and coordination from physicians, nurses, family members, therapists, psychologists and others, according to new guidelines from the American Heart Association (AHA) and the American Stroke Association (ASA).
The AHA and ASA  recommend that stroke patients undergo treatment at in-patient rehabilitation facilities instead of skilled nursing facilities.
The guidelines were published in  Stroke on May 4. They were also endorsed by the American Academy of Physical Medicine and Rehabilitation, American Physical Therapy Association, American Occupational Therapy Association, American Society of Neurorehabilitation and American Congress of Rehabilitation Medicine.
“If the hospital suggests sending your loved one to a skilled nursing facility after a stroke, advocate for the patient to go to an in-patient rehabilitation facility instead – unless there is a good reason not to – such as being medically unable to participate in rehab,” Carolee J. Winstein, PhD, the chair of the guidelines committee, said in a news release. “There is considerable evidence that patients benefit from the team approach in a facility that understands the importance of rehabilitation during the early period after a stroke.”
Although the researchers noted that the relative rate of stroke deaths decreased by 35.8 percent between 2000 and 2010, they mentioned that nearly 800,000 people have a stroke each year. Of the stroke survivors, more than two-thirds receive rehabilitation services when they leave the hospital.
Members of the writing group reviewed articles published through 2014 on adults who suffered strokes.
“Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others,” the researchers wrote. “Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential.
”
The guidelines also suggest that caregivers insist stroke survivors participate in a program on preventing falls before getting discharged from hospital. Patients should also have mobility-tasking training and individually tailored exercise programs, while some should have speech therapy and balance training programs.
In addition, the researchers recommended ideas for future research, including examining multimodal interventions, patient-centered outcomes and prediction models to identify responders and nonresponders to different therapies.
“As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed, but without recognition of their clinical impact and their ability to reduce the risk of downstream medical morbidity caused by immobility, depression, loss of autonomy, and reduced functional independence,” they wrote. “The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. We hope that these guidelines help inform these efforts.”

We want to hear your stroke story - it could influence scientific research!

From the AHA and PCORI, I'm going to be sending in the lack of interventions to the neuronal cascade of death. Send in yours, we need to somehow convince the powers that be that there are vast problems in stroke needing to be solved. Don't be polite. I may have to really hold myself back from writing a 5000 word screed. They obviously don't follow social media at all, all this is already available on stroke forums and blogs. I bet they ignore everything and just focus on their preconceived notions anyway. By focusing on unmet care they have announced that they really don't want to solve any of the problems in stroke just rearrange the deck chairs on the Titanic.
1. Make neuroplasticity repeatable on demand.   
2. Make neurogenesis repeatable on demand.
3. Solve spasticity, Ignore Dr. William M. Landaus' pronouncements on this. 
4. Solve fatigue.
5. Solve aphasia. 

We want to hear your story - it could influence scientific research!

Your experience could lead to the next research study to improve heart disease and stroke treatment.
If you or a loved one have had a heart attack, suffered a stroke, or are living with any kind of cardiovascular disease, your unique understanding could help guide research to solve un-met care challenges faced by individuals like you and improve heart and stroke treatment.

We want to hear your story.

In a groundbreaking collaboration, the American Heart Association (AHA) and the Patient-Centered Outcomes Research Institute (PCORI) offer you the opportunity to play a key role in influencing topics for future scientific research through a new challenge.
We invite you to share your experience, the decisions made in determining your or your loved one's treatment plans and the factors that influenced those decisions. We want to better understand your experience in order to guide research that will lead to better care tailored to the specific needs of patients.
Here are the details:

• We are focused on un-met challenges faced by patients and caregivers like you.
• To join this challenge, you'll be asked to provide a written submission of your first-hand experience after a heart disease or stroke event.
• The story and description of the concerns you faced and the decisions you made should be personal and not a general case.(Why limit it to specific? That way you can ignore survivors knowledge of what needs to be done in general?)
• A team of scientific professionals and patient representatives with expertise in heart disease and stroke will review your story. Learning more about issues and concerns important to your decision-making can help them improve experiences and outcomes for patients in the future.
• If your submission is chosen, you could win $1,000 and possibly help shape the future of cardiovascular research.
• All submissions must be received by June 8, 2016.

Please take this important challenge and share your insights. Your story matters. Click below to enter this crowdsourcing challenge through InnoCentive's global challenge marketplace.