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Adapting Secondary Stroke Prevention Programs to Local Resource Structures and Front Line Input

Damush T, Plue L, Schmid A, Kent TA, Anderson JA, Murphy C, Kimmel B. Adapting Secondary Stroke Prevention Programs to Local Resource Structures and Front Line Input. Stroke; A Journal of Cerebral Circulation. 2009 Apr 1; 40(4):e280.

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Abstract:

Objectives: The objective was to conduct a formative evaluation of stroke patients, their providers and the hospital discharge process to understand the barriers and facilitators of activating veterans with recent stroke or TIA through peer support to improve control of stroke risk factors, provide feedback on how best to adapt existing stroke prevention tools to veterans and the VHA system of healthcare, and develop an implementation strategy based on this feedback. Methods: This study is a dual-site (Indianapolis and Houston VAMC), feasibility implementation study incorporating qualitative and quantitative data to inform the adaptation of existing stroke prevention tools through peer support to the VA and to test the feasibility of an implementation strategy. To accomplish these aims, we conducted focus groups of veteran stroke and TIA patients and semi-structured interviews of VA providers of stroke care (physicians, nurses and therapists) to inform how the program can best be integrated into the existing systems of care. Major themes of facilitators and barriers to stroke risk factor management were identified in an iterative manner from the qualitative data analyses. Results: The Indianapolis providers stated a need for a systematic delivery of secondary stroke prevention including for example a stroke discharge template. In addition, they desired training on how to best deliver to patients including specific scripts on specific risk factors. Houston providers were aware of the many programs and resources available to stroke patients; but did not know how to access or refer to such programs. In addition, these providers identified cognitive difficulties as prevalent in their stroke population and wished for methods to assist these patients. Stroke survivors endorsed peer support to inform them of expectations for recovery and to help navigate the VA system. Veterans offered suggestions for delivering support to veterans from acute hospitalization to recovery. Next, we will adapt existing stroke risk factor management tools using a stroke expert panel, and a panel of stroke patients and caregivers. Impact: This study will: 1) develop an evidence-based, implementation strategy to adapt existing stroke tools for stroke prevention in the VA; and 2) estimate the effect size to test the impact of future regional and national roll outs. In doing so, we will assist VA with compliance to VA/DoD and JC stroke care guidelines and potentially improve HRQOL of veterans




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