Community care coordination for stroke survivors: results of a complex intervention study
Abstract Background Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multi...
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doaj-ee8bbf6567094566ad49238193108e822020-12-20T12:06:33ZengBMCBMC Health Services Research1472-69632020-12-0120111310.1186/s12913-020-05993-xCommunity care coordination for stroke survivors: results of a complex intervention studyJohannes Deutschbein0Ulrike Grittner1Alice Schneider2Liane Schenk3Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthInstitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthInstitute of Biometry and Clinical Epidemiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthAbstract Background Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. Methods Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models. Results In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality. Conclusion This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care. Trial registration DRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019).https://doi.org/10.1186/s12913-020-05993-xCare coordinationStrokeHealth care utilizationReadmissionsCostsGermany |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Johannes Deutschbein Ulrike Grittner Alice Schneider Liane Schenk |
spellingShingle |
Johannes Deutschbein Ulrike Grittner Alice Schneider Liane Schenk Community care coordination for stroke survivors: results of a complex intervention study BMC Health Services Research Care coordination Stroke Health care utilization Readmissions Costs Germany |
author_facet |
Johannes Deutschbein Ulrike Grittner Alice Schneider Liane Schenk |
author_sort |
Johannes Deutschbein |
title |
Community care coordination for stroke survivors: results of a complex intervention study |
title_short |
Community care coordination for stroke survivors: results of a complex intervention study |
title_full |
Community care coordination for stroke survivors: results of a complex intervention study |
title_fullStr |
Community care coordination for stroke survivors: results of a complex intervention study |
title_full_unstemmed |
Community care coordination for stroke survivors: results of a complex intervention study |
title_sort |
community care coordination for stroke survivors: results of a complex intervention study |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2020-12-01 |
description |
Abstract Background Outpatient follow-up care for stroke survivors is often inadequate and mostly self-organized by the patients themselves. In the German health care system, there are no standard care programs for patients after they are discharged from the hospital to support them with their multifaceted and heterogeneous health care needs. The objective of this complex intervention study was to evaluate the effectiveness of a post-stroke care coordination program in comparison to standard care in the first year after a stroke. Methods Patients aged 55 and older who had survived a stroke or a transient ischemic attack (TIA) within the last 6 months before enrollment were included. Participants received care coordination either by telephone or face-to-face for up to 1 year. Patients’ health insurance claims data were used to measure outcomes. The control group consisted of stroke survivors receiving standard care and was constructed by exact matching based on six criteria. Outcome measures were health services utilization, rate of recurrent events, readmissions and accompanying costs, and mortality. Outcomes were tested using different multiple models. Results In total, N = 361 patients were included in the analyses. Intervention participants had seen an outpatient neurologist more often (OR = 4.75; 95% CI: 2.71–8.31) and were readmitted to a hospital less frequently (IRR = 0.42; 95% CI: 0.29–0.61), resulting in lower hospital costs (IQR = €0–1910 in the intervention group, IQR = €0–4375 in the control group). There were no substantial group differences in the rate of recurrent events and mortality. Conclusion This study showed the beneficial potential of care coordination for a vulnerable patient population: the utilization rate of important health services was increased, and the rate of hospital readmissions decreased as a result. Future research should focus on the risk of recurrent strokes and the long-term effects of improved care. Trial registration DRKS00017526 on DRKS – German Clinical Trials Register (retrospectively registered: 21 June 2019). |
topic |
Care coordination Stroke Health care utilization Readmissions Costs Germany |
url |
https://doi.org/10.1186/s12913-020-05993-x |
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