Effectiveness of a Care Coordination Model for Stroke Survivors: A Randomized Study‪.‬

The primary purpose of this randomized study was to measure the effectiveness of a biopsychosocial care coordination model implemented by social workers. It was provided to individuals surviving cerebrovascular accident (CVA), commonly known as stroke. This model, designed to deliver quality care in a managed care cost-containment environment, systematically coordinates care across an array of health services. It aims to facilitate patient physical and psychosocial function and to reinforce prescribed medical care among this high-risk, chronically ill population. To date, only a few empirical studies in social work have investigated the effectiveness of care coordination in health care (Cherin, Simmons, & Hillary, 1998; Eggert, Zimmer, Hall, & Friedman, 1991; Larson &Tobin, 2000; Lawlor & Raube, 1995), and none are specific to the stroke population. This investigation asks the following two questions: (1) Does care coordination provided by social work improve patient well-being? (2) Does it significantly support patients' adherence to self-care practices? Stroke is the third leading cause of death and is a leading cause of serious, long-term disability. Approximately 5,400,000 stroke survivors are alive today, with more than 1,100,000 of these individuals experiencing some level of functional disabilities related to activities of daily living (American Heart Association, 2004). In addition, approximately 72 percent of all people who experience a stroke are 65 years old, and 45 percent of all stroke survivors 65 years old or older experience moderate or severe disability (Centers for Disease Control and Prevention, 2005). Clinical guidelines for stroke patients identify the period immediately following hospitalization as a high-risk one (Matchar & Samsa, 2000).Therefore, postdischarge assessments to monitor patient adaptation and independent living are necessary. Additional support services may be required because of psychosocial issues, family support, social functioning, postdischarge environments, and reintegration into the community (Angeleri, Angeleri, Foshi, Giaquinto, & Nolfe, 1993; Gordon & Hibbard, 1997).