Abstract 55: An Integrated Stroke Practice Unit Model Can Impact Blood Pressure Management Post-Stroke


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Abstract

Introduction: Stroke care involves multiple mechanisms and high risk and cost. Even when initial acute events are managed successfully, patient risk remains high for stroke recurrence and readmission for stroke-related causes that negatively impact recovery. Hypertension, the main modifiable risk factor for stroke, accounts for ≤50% of recurrent strokes. Blood pressure (BP) management for stroke post-discharge often combines risk education, lifestyle modification, and medication compliance, but insufficient evidence has complicated provider response.Methods: An Integrated Stroke Practice Unit (ISPU) Model was implemented in New Orleans (2012-2015) that combines integrated technology and real time response to improve care coordination from symptom onset through 12-months post-discharge. Stroke Central included patients hospitalized with suspected stroke symptoms, and Stroke Mobile included patients discharged with a stroke diagnosis residing in St. Tammany or Jefferson Parishes. Stroke Mobile patients were followed at home monthly to assess recovery, manage comorbidities, and provide risk/recovery/recurrence education and caregiver/family support; comprehensive BP management and education were key goals. BP at goal was defined as 140/90 and was measured at each visit (12 total); BP issues were proactively followed and resolved.Results: From February 2013-December 2015, 558 patients were seen at least one time in Stroke Mobile, and 192 patients completed 12 visits. Of those who completed the program, patients whose blood pressure was controlled at each visit ranged from 78.2%-93.2%, which is higher than in previously reported studies. Overall, increased control was seen overtime from visits 1-12; additional analyses will examine this in more detail.Conclusions: A comprehensive ISPU approach, combined with targeted education and caregiver/family focus, can be effective for managing BP post-stroke.

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