For many stroke patients and caregivers, the transition back to home is often complex resulting in hospital readmissions, poor quality of life, and high caregiver burden. Providing access to high quality information on stroke is a potential cost effective intervention to improve stroke transitions. We report on the development and utilization of a patient-centered web-based tool that complemented a case management intervention which were both tested in the Michigan Stroke Transitions Trial (MISTT), an RCT designed to improve the transition experience for stroke patients and caregivers.
Methods/Methodology: A social work case management (SWCM) program was designed to address patient and caregiver needs, improve quality of life, and decrease caregiver burden. In addition, we addressed informational needs by developing a curated, patient-centered website with access to communication, information, and support resources. Website content and structure were developed through focus groups with key patient, caregiver, and provider stakeholders. Refinements were made after structured usability and accessibility testing. Acute stroke patients (N=263) discharged home from three acute-care hospitals were randomly assigned to one of three groups: usual care, SWCM, or SWCM plus website access. For the 87 subjects randomized to the website group, utilization was monitored over the 90-days intervention period by Google Analytics ® which generated data on log-in sessions and page views.
Results: Utilization data demonstrated that approximately one third (n= 28) of eligible patient/caregiver dyads randomized to the website did not access the website at all. Among website users, 25% (n=14) only accessed the site when assisted during SWCM home visit; another 25% (n=14) logged in 1-5 times in addition to the first home visit; and the remaining 50% (n=28) logged in on their own 1 to 9 times. The most popular pages were stroke information, medication information, stroke recovery, and prevention.
Conclusion: Despite the fact that stakeholders report the need to access reliable stroke information during the transition home, we found that utilization of a website designed for this purpose was low. These analyses identify areas for further research and program development.