Development of Stroke After-Care in the Rotterdam Stroke Service

Background

Hospitals, rehabilitation nursing homes, rehabilitation centers and home care organizations collaborate in the Rotterdam Stroke Service in the Netherlands to provide the best quality of care for stroke patients in the chronically phase. After a stroke, patients are confronted with physical disabilities and changes in cognition and behavior. Moreover, caregivers, children and spouses are faced with multiple challenges related to this vulnerable patient group. Nowadays patient receive adequate care and support in the home environment after discharge from the hospital, rehabilitation nursing home or rehabilitation centre. The specialized care and support is offered by specialized stroke nurses who taught patients to cope with disabilities and changing roles after stroke. Better coping may lead to a decrease of complications on all life domains: less caregiver burden, fewer alcohol and medication abuse, better mobility and more social activity.

Method

Eight hospitals, nine rehabilitation nursing homes, a rehabilitation hospital, diverse home care organizations and a specific network of home care professionals are collaborative partners within the RSS. From April 2012-November 2013, a taskforce had the goal to design a “stroke after care” research plan. The project was funded by the Dutch Institution ZonMW. In 2015 (after the project phase), stroke after care became “care as usual “in the RSS. Patients receive out-reached nursing support consisting of home visits. The specialized nurses collect demographic data, assess functional abilities and use standardized checklists to record a wide range of problems that patients express.

Results

Data were collected in two time periods: November 2013-June 2015 (1) and June 2015-Januari 2016 (2). In the first time period, 148 patients and in the second time period, 270 patients received out-reached nursing support. Patients were on average 68 years old and 46% compared to 53% were female. Of these patients, 85% compared to 82% have had a Cerebro Vascular Accident and the remaining patients have had a Transient Ischemic Attack. The majority of the patients were discharged back home from the hospital. Patients had on average three contact moments with the nurse in the first three months after discharge. After stroke, patients reported problems concerning ADL (51% and 15% respectively), cognition (49% and 9% respectively), communication (45% and 4% respectively) and emotion (32% and 3% respectively). In the second time period there were also a few other variables measured: exhaustion (15%), IADL (6%) and social activities (6%).

Discussion/conclusion

There are large differences in reported problems between the two time periods. It is unclear how those differences can be explained. Nevertheless, nurses, patients and managers are convinced that stroke after-care improves quality of care after stroke. Still, there is a major challenge for organizations to find financial recourses to offer stroke after care in the future in the Rotterdam area, because so far health care insurance does not cover the costs. However, the participants of the RSS are continuing to offer stroke after care. Meanwhile the results are promising and patients’ express their gratitude, and therefore the issue may be impactful in meetings with health care insurers.