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Steps Against Recurrent Stroke Plus: Patient Transition Program

Bretz, Miranda N.; Graves, Alex; West, Angie; Kiesz, Karen C.; Toth, Lynn; Welch, Marie

Journal of Neuroscience Nursing: August 2014 - Volume 46 - Issue 4 - p E3–E13
doi: 10.1097/JNN.0000000000000065

ABSTRACT Stroke is a devastating health event that affects 800,000 people annually in the United States. Nearly 20% of strokes are recurrent strokes. Research shows that support after discharge from the hospital poststroke is frequently inadequate. The purpose of “Steps Against Recurrent Stroke (STARS) Plus: Patient Transition Program” was to design and deliver a program to facilitate optimal recovery for stroke survivors and prevent recurrent stroke. The program began at discharge from the hospital and continued through the first year of rehabilitation and recovery. Twelve hospitals participated; 261 patients enrolled, and contact was established with 193. Outcomes were gathered based on patient self-report of health status using the Short-Form Health Survey at 30, 90, 180, and 360 days. A dependent sample t test was completed comparing participants’ 30- and 360-day follow-up scores. Results demonstrated an overall increase in subjective pain. A repeated multivariate analysis of variance was conducted to compare 30- and 360-day Short-Form Health Survey scores across age and subscales. Results revealed that those in the younger and older age groups reported poorer health outcomes. Findings demonstrate a reduction in rehospitalization after stroke, increased medication adherence, strong patient satisfaction, and significant differences in health-related outcome measures across age groups, suggesting that middle-aged stroke survivors experience better health outcomes than younger or older age groups. Future programs should consider targeting pain management in all ages and education targeted at younger and older age groups, because they reported poorer health outcomes. The findings from this program should contribute to the guidance and insight for others developing transitional interventions for stroke survivors.

Questions or comments about this article may be directed to Miranda N. Bretz, MA, at She is a Research Analyst at National Stroke Association, Centennial, CO.

Alex Graves, MS ANP, is the Clinical Director of Stroke Service at University of Colorado Hospital, Aurora, CO.

Angie West, RN MSN CCRN CNRN, is the Program Director Neuroscience/Stroke at Memorial Stroke Center, Long Beach Memorial Hospital, Long Beach, CA.

Karen C. Kiesz, RN MN CNRN, is the Stroke Program Manager at MultiCare Health System Caroline Administration, Tacoma, WA.

Lynn Toth, RN MSN NP-C, is a Cardiovascular Medical Specialist at Beebe Medical Center, Lewes, DE.

Marie Welch, RN MSN MS CRRN, is a Stroke Coordinator and Clinical Nurse Specialist at Vidant Health, Greenville, NC.

The Steps Against Recurrent Stroke Plus Program was sponsored by Charitable Contributions from the Bristol–Myers Squibb/Sanofi Pharmaceuticals Partnership and Allergan, Inc. The authors declare no conflicts of interest.

© 2014 American Association of Neuroscience Nurses