Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics.
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2019-11-04
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AIM:To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3-12 months post-stroke in Singapore. METHODS:Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome. RESULTS:Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with a child caregiver had an almost three times greater rate of hospitalizations over 3-12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at the 3-month point was associated with the higher subsequent rate of hospitalization. CONCLUSION:Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.
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Tyagi, Shilpa, Gerald CH Koh, Nan Luo, Kelvin B Tan, Helen Hoenig, David B Matchar, Joanne Yoong, Angelique Chan, et al. (2019). Dyadic approach to post-stroke hospitalizations: role of caregiver and patient characteristics. BMC neurology, 19(1). p. 267. 10.1186/s12883-019-1510-4 Retrieved from https://hdl.handle.net/10161/22776.
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Helen Marie Hoenig
- General Focus and Goals of Research: Dr. Hoenig's research career centered on geriatric rehabilitation, and included use of technology to ameliorate disability, improving access to care via telerehabilitation, and developing key conceptual models to guide rehabilitation practices. She led work diverse novel approaches to care across the Veterans Health System, including the development and implementation of the VA Spinal Cord Injury & Disorders Registry and the Asynchronous Telehealth My VA Images mobile app. Dr. Hoenig has been involved in global health research on telerehabilitation, community mobility and global rehabilitation needs. Currently, Dr. Hoenig is enrolled in the Hybrid mDiv Program at Duke Divinity School to explore the interface of science, art and theology.
- Specific Approaches or Techniques: Randomized controlled trials, large database analyses and survey research. Her clinical research included studies on rehabilitation intervention studies (e.g., provision of mobility aids) and novel ways to improve access to rehabilitation (e.g., group physical therapy, telerehabilitation). Epidemiological studies and survey research have examined factors exacerbating or ameliorating disability, including medical complications such as fractures, environmental factors, use of assistive technology, and daily activity participation. Her research has ranged from single and multisite studies, to nationwide epidemiological studies, and global health research.
- Special areas of expertise/national recognition: Rehabilitation health services research, geriatric rehabilitation, assistive technology outcomes, telerehabilitation.
KEY WORDS/PHRASES: Rehabilitation, Telehealth, Geriatrics, Disability. Art, Theology
David Bruce Matchar
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
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