Intersectoral organized care of complex chronic diseases: Stroke navigators in East Westphalia-Lippe - STROKE OW
- Conditions
- I60I61G45I62I63I64Subarachnoid haemorrhageIntracerebral haemorrhageStroke, not specified as haemorrhage or infarctionOther nontraumatic intracranial haemorrhage
- Registration Number
- DRKS00030297
- Lead Sponsor
- Stiftung Deutsche Schlaganfall-Hilfe
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Complete
- Sex
- All
- Target Recruitment
- 1512
Patients after stroke with ICD numbers I60 - I64 as well as G45 (TIA),
- Minimum age: 18 years
- Modified Rankin Scale (mRS, Sulter et al. 1999): 0, 1, 2, 3 or 4 when approached by the controllers on the stroke unit
- No existing level of care or existing level of care 1, 2, 3 before current stroke
- Patients with first stroke: no stroke (ICD I60-I64; G45) within the last 4 quarters before the quarter of the current stroke
- Patient's place of residence within the catchment area (OWL)
- Practice of the treating general practitioner in the billing area of the Kassenärztliche Vereinigung Westfalen-Lippe
- membership with TK, IKK classic, BKK, DAK, AOK-NordWest or Barmer without notice of cancellation (continuous insurance in the four quarters before the quarter of the stroke)
- good German language skills to understand and give informed consent to the informed consent form and to complete the quality of life questionnaires
- Age: under 18 years
- mRS: 5 or 6 when contacted by the stroke navigators at the stroke unit
- Existing level of care 4 and 5 before current stroke (to be identified in routine data over the last 4 quarters before the index quarter)
- Existing long-term inpatient care before current stroke (to be identified over the last 4 quarters before the index quarter)
- previous stroke (ICD I60 - I64 or G45.0 within the last 4 quarters before the quarter of the current stroke)
- Outpatient or inpatient treatment for any of these diagnoses within the index quarter or the last 4 quarters before the quarter of the current stroke:
- C00.- to C97 (malignant neoplasms).
- G30.- † (Alzheimer's disease) or G31.- (Other degenerative diseases of the nervous system, not elsewhere classified)
- F00 to F09 (Organic, including symptomatic mental disorders)
- F10 to F19 (Mental and behavioral disorders due to psychotropic substances), excluding diagnosis F17.- (Mental and behavioral disorders due to tobacco)
- F20 to F29 (Schizophrenia, schizotypal and delusional disorders)
- F30.- (Manic episode)
- F31.- (Bipolar affective disorder)
- Patient's place of residence outside the catchment area (OWL)
- Practice of the treating general practitioner outside the billing area of the Kassenärztliche Vereinigung Westfalen-Lippe
- Membership with a non-cooperating GKV; membership with a PKV
- insufficient knowledge of the German language, which prevents the patient from actively participating in the project
Study & Design
- Study Type
- interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method The evaluation of the STROKE project is based on the following hypothesis: Compared to a control group of stroke patients from a comparison region, after an observation period of one year after the initial stroke, the recurrence rate in the intervention group of stroke patients who were cared for by stroke navigators will decrease by at least 30%.
- Secondary Outcome Measures
Name Time Method Quality of life (during the course, general; EQ-5D-5L); quality of life (during the course, indication-specific; Stroke Impact Scale); extent of impairment due to stroke (mRS); activities of daily living (Barthel index); smoking status; physical activity; Death and cause of death; Vascular events (myocardial infarction, vascular death); Blood pressure; Cholesterol; HbA1c; Mortality; Hospitalization (vascular cause); Nursing home/level of care; Drugs; Secondary prophylaxis (guideline-based pharmacotherapy); Costs.