Stroke care coordination team: Emerging roles to improve patient outcomes

Abstracts urinary incontinence program in the long term care environment and identify at least three advantages of the approach. List four classifications of urinary incontinence and the relevant physical therapy treatment options for each. Identify tools that can be used to evaluate the efficacy of a transdisciplinary urinary incontinence program. Vascular Risk Factors in Cocaine Users With Stroke. S. Sen and S. Silliman (Albert Einstein Medical Center,

Philadelphia, PA) Objective: to determine if vascular risk factors (chronic hypertension (HTN), diabetes, cigarette smoking, alcohol abuse, older age and male sex) are associated with cocaine related ischemic stroke (IS) and hemorrhagic stroke (HS). Background: IS and HS are complications of cocaine use. Factors that modify a cocaine user's chance of having a stroke have not been identified. Methods: The records of 100 patients admitted to two institutions with IS or HS and a positive urine test for cocaine were reviewed. The IS and HS groups were compared to a control group of 109 cocaine users without a history of stroke. Multiple logistic regression was performed to see if the vascular risk factors, entered simultaneously, were associated with stroke. Results: 66 cocaine related strokes were IS and 34 were HS (16 intracerebral, 18 subarachnoid). The study and control groups were not different with respect to sex or racial composition, but mean age of the controls (34, SD 6.9) was tess than the mean age of patients with IS (41, SD 10.6) or HS (41, SD 7.6). Only HTN (OR 5.2, P < .001) and older age (OR 1.08/year increase of age, p < 0.001) were independently associated with IS. Only female sex (OR 3.2, p < 0.015) and older age (OR 1.1/year increase of age, P < .001) were independently associated with HS. Conclusion: Chronic hypertension, older age, and female sex may magnify the risk of stroke associated with cocaine use. Stroke Care Coordination Team: Emerging Roles to Improve Patient Outcomes. Deborah Summers, Iris Standridge, Martha Maccracken

Traditionally, discharge planning at Saint Luke's Stroke Center was done by a multidisciplinary team in a weekly meeting. Decreased patient lengths of stay led to inconsistent discharge planning and became a challenge to the team. A multidisciplinary team formed a task force to determine how to improve patient clinical outcomes and satisfaction, reduce cost, and improve efficiency of care through hospitalization. A Care Coordination Team emerged which restructured three positions within the stroke center. The defined purpose of the team is to improve the resource management, discharge planning,

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and continuum of patient care through redesign and streamlining of current functions and processes. The team composition includes a Clinical Nurse Specialist, Social Worker and Utilization Management Nurse. Restructuring of these roles provides daily evaluation, planning and intervention for these patients by collaborating with interdisciplinary team members, physicians, and direct care providers. Team accountability includes appropriate resource utilization, coordination and meeting financial goals for all stroke patients. In the early phase of implementation the Care Coordination Team has demonstrated: increased continuity and efficiency in care planning and discharge planning, increased physicians and patient satisfaction, and increased awareness of utilization of health care resources. Prior TIAs Fail to Produce Ischemic Tolerance in Clinical Stroke. Wayne M. Clark, Nancy Beamer, Samantha Hazel, Ellen Harrison, Michael Wynn, Bruce M. CouI1

(Oregon Stroke Center, OHSU, Portland, OR) Recent experimental studies have found that prior exposure to brief periods of ischemia reduces the severity of subsequent CNS ischemic injury. This "ischemic tolerance" may be mediated by HSP induction. In this study we determined if stroke patients who had TIAs preceding their stroke have an improved 6-month outcome compared to patients without prior events. Baseline NIH stroke scales (NIHSS), WBC and fibrinogen values were obtained on 110 acute ischemic stroke patients. Twentyseven of these patients (25%) had a well-defined transient ischemic attack (TIA) preceding their stroke. Qualitative CT infarct size (5 point scale: 1 = <0.5cm, 2 = 0.5-<1cm, 3 = 1-3cm, 4 = >3cm, 5 = multibolar) was obtained at 1 week and long-term outcome was determined by 6-month NIHSS and Glasgow assessments. Results: Baseline: NIHSS: PreTIA 4.9 + 5.5, No TIA 5.8 + 5.5; WBCs (1000/ram3): PreTIA 7.9 + 2.4, No TIA 7.9 + 2.3; fibrinogen (mg/dL): PreTIA 386 + 134, No TIA 395 + 97. One week CT: PreTIA 2.8 + 1.3, No TIA 2.6 + 0.9. Six month: NIHSS: PreTIA, 2.9 + 4.1, NO TIA 2.7 + 4.0; Glasgow: PreTIA 1.4 + 0.6, No TIA 1.7 + 0.8 (All NS). These results indicate that a preceding TIA did not improve neurologic or functional outcome in this clinical study. U.S. National Survey of Stroke Prevention Practices: Asymptomatic Bruit. Larry B. Goldstein, Arthur J. Bonito, David B. Matchar, Gregory P. Samsa (Duke University,

Durham, NC) Between August 1993 and February 1994, we surveyed the stroke prevention practices of a random sample of 2000 U.S. physicians stratified by primary specialty (noninternist primary care, internists, neurologists and surgeons). The survey queried the use of diagnostic studies