For some stroke patients and caregivers, navigating the transition between hospital discharge and returning home is associated with substantial psychosocial and health-related challenges. Currently, no evidence-based standard of care exists that addresses the concerns of stroke patients and caregivers during the transition period. Objectives of the Michigan Stroke Transitions Trial (MISTT) are to test the impact of a social worker home-based case management program, as well as an online information and support resource, on patient and caregiver outcomes after returning home.
The Michigan Stroke Transitions Trial is a randomized, pragmatic, open (un-blinded), 3-group parallel designed superiority trial conducted in 3 Michigan hospitals. Eligible participants are adult acute stroke patients discharged home directly or within 4 weeks of being discharged to a rehabilitation facility. The patient’s primary caregiver is also invited to participate. Patients are randomized on the day they return home using a randomized block design. Consented patients discharged to a rehabilitation facility who do not go home within 4 weeks are dropped from the study.
The 2 study interventions begin within a week of returning home and conclude 3 months later. The 3-group design compares usual care to either a home-based social worker stroke case management (SWSCM) program, or a combination of the SWSCM program plus access to an online information and support resource (MISTT website). Outcomes data are collected at 7-days and 90-days by trained telephone interviewers. Primary patient outcomes include the PROMIS global 10 score (a generic Quality of Life scale), and the Patient Activation Measure (PAM). Caregiver outcomes include the Bakas Caregiving Outcomes Scale. Final analysis will be based on 214 randomized acute stroke patients. To accommodate subjects excluded due to prolonged rehabilitation stays, as well as those lost-to-follow-up, up to 315 patients will be consented.
The MISTT study will determine if a home-based case management program designed around the needs and preferences of stroke patients and caregivers, alone or in combination with a patient-centered online information and support resource can improve stroke survivor and caregiver outcomes 3 months after returning home.
ClinicalTrials.gov: NCT02653170 (Protocol ID: 135457). Registered April 9, 2015.
Pew Research Center: Family Caregivers Online. Washington, D.C.: Pew Internet and American Life Project; 2012.
National Alliance for Caregiving: Caregiving in the U.S. 2009.
Han B, Haley WE. Family caregiving for patients with stroke. Review and analysis Stroke. 1999;30(7):1478–85. PubMed
Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, et al. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev. 2012;
Astrom M, Asplund K, Astrom T: Psychosocial function and life satisfaction after stroke. Stroke 1992, 23(4):527–531.
Hoffmann T, McKenna K, Worrall L, Read SJ. Evaluating current practice in the provision of written information to stroke patients and their carers. International Journal of Therapy and Rehabilitation. 2004;11(7):303–10. CrossRef
Legg LA, Quinn TJ, Mahmood F, Weir CJ, Tierney J, Stott DJ, et al. Non-pharmacological interventions for caregivers of stroke survivors. Cochrane Database Syst Rev. 2011;10:CD008179.
Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The importance of transitional care in achieving health reform. Health Aff. 2011;30(4):746–54. CrossRef
Sands RG. Clinical social work practice in behavioral mental health: a postmodern approach to practice with adults. 2nd ed. Boston, MA: Allyn & Bacon; 2001.
National Stroke Association. http://www.stroke.org. Accessed 12 June 2017.
American Stroke Association. http://www.strokeassociation.org. Accessed 12 June 2017.
United Way. Michigan 2–1-1. http://www.mi211.org/. Accessed 12 June 2017.
National Stroke Association. Stroke Support Groups. http://www.stroke.org/stroke-resources/stroke-support-groups. Accessed 12 June 2017.
National Institues of Health. HealthMeasures (Patient-centered Assessment Resource). http://www.healthmeasures.net/. Accessed 12 June 2017.
SAS Institute Inc., SAS Version 9.4. Cary, NC, USA.
Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–92. PubMed
Helfand M, Berg A, Flum D, Gabriel S: Methodology Report: Standards for Patient--centered Outcomes Research. Patient-Centered Outcomes Research Institute (PCORI) Methodology Committee. Vol. 23; 2012.
Piantadosi S. Clinical trials: a methodologic perspective, John Wiley & Sons. NJ, USA.: Hoboken; 2005. CrossRef
Kenny DA, Kashy D, Cook WL: Dyadic data analysis: Guilford press; 2006.
National Quality Forum: Measuring Framework: Evaluation Efficiency Across Patient-Focussed Episodes of Care . Washington, DC: 2009.
Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff. 2009;28(1):75–85. CrossRef
Findley PA. Social work practice in the chronic care model: chronic illness and disability care. J Soc Work. 2013;
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20(6):64–78. CrossRef
Claiborne N. Effectiveness of a care coordination model for stroke survivors: a randomized study. Health & Social Work. 2006;31(2):87–96. CrossRef
Agency Healthcare Research and Quality. Innovations Exchange: Hospital-based social workers follow up with recently discharged older adults to resolve transition problems, reducing readmissions and deaths. In: Service Delivery Innovatoin Profile. Washington, D. C. 2013.
Fryer CE, Luker JA, McDonnell MN, Hillier SL: Self-management programs for quality of life in people with stroke. Stroke 2016, 47(12):e266-e267.
- Improving transitions in acute stroke patients discharged to home: the Michigan stroke transitions trial (MISTT) protocol
Mathew J. Reeves
Anne K. Hughes
Amanda T. Woodward
Paul P. Freddolino
Constantinos K. Coursaris
Sarah J. Swierenga
Lee H. Schwamm
Michele C. Fritz
- BioMed Central