N.C. Study Looks at Post-acute Stroke Services

Jan. 29--A stroke can be a life-altering event, and one that can leave many patients feeling overwhelmed.

"I once told a patient it's almost like being reborn again as a totally different person. You have a whole new skill to learn because you have the deficits," said James Hood, of Lenoir County Emergency Services and commander of the UNC Lenoir Health Care's Community Paramedic program.

After being discharged from the hospital, some stroke patients find themselves unable to perform even basic functions, such as writing or speaking the way they could before the stroke.

"A lot of people aren't able to go back to their old jobs because they can't do what they used to do," Hood said.

To help ease the transition from the hospital to day-to-day life, the hospital has joined in a five-year study aimed to change the way hospitals treat stroke patients.

The study, entitled COMPASS -- an acronym for comprehensive post-acute stroke services -- is a $14 million endeavor across 41 hospitals.

For their part in the study, UNC Lenoir Health Care has changed the way it cares for patients after they leave the hospital for initial treatment after a stroke.

"In the past, we would discharge the patient, and they would see their primary care provider, but they would not see (a neurologist) for four to six weeks," Dawn Becker, registered nurse and coordinator of the stroke program at UNC Lenoir Health Care, said. "Really no one from the hospital followed them in that time period."

During that time frame, patients would receive an in-home visit from Hood, through the hospital's community paramedic program, but otherwise would largely be on their own.

This meant patients who didn't understand their medications or part of their treatment plan were left in the dark until they either saw a physician or were readmitted to the hospital.

Because of the risk factors associated with strokes -- smoking, high cholesterol, diabetes, irregular heartbeat and obesity -- readmissions of stroke patients after they are sent home are common.

Considering Lenoir County's position in the United States Stroke Belt, a region where strokes occur at a much higher rate than the rest of the country, such readmissions are relatively common.

Under the COMPASS program, either Becker or Hood counsel patients on their treatment plan before they leave the hospital.

Two days after leaving the hospital, patients get phone calls from the hospital to see if any issues have arisen since they went home. A few days later, Hood conducts an in-home visit with patients to conduct fall tests, review diets and other risk factors, and see if he can address any issues a patient may have.

"Usually you are able to find a lot more out about patients at home than in the hospital," he said. "There's no set number of visits. Every patient gets at least one visit; some require two or three visits after that, others require more visits over months."

Within two weeks of being discharged from the hospital, patients see a neurologist for an initial assessment, and can be recommended for any extra care necessary.

"We are focusing on really transitioning the patient back to as high a level of function as possible and to regaining their life within the community," Becker said.

The idea behind the model of care program is not only to speed up the rate at which patients are getting the care they need, but also to reduce the number of hospital readmissions to the hospital after a stroke.

If successful, the compass model will not only be a boon to a region with a high number of stroke patients, but could also change the way the hospital treats other patients.

"Even after the study ends, we plan to continue this model of care forever, unless it proves to be ineffective," Becker said.

Dustin George can be reached at 252-559-1077 or Dustin.George@Kinston.com. Follow him on Twitter @DustinGeorgeKFP.

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