背景:初次中风或短暂性脑缺血发作(TIA)的患者有进一步中风的高风险,死亡或心血管事件。即使是第一次中风也与残疾和需要帮助的高机会有关。长期医疗保健需求的风险随着每次后续事件的发生而增加。尽管德国的住院部门已经提供了高标准的护理,很难获得跨部门的善后护理。因此,该研究调查了结构化病例管理计划是否可以避免卒中复发.
方法:该研究是在北莱茵-威斯特法伦州的三个地区进行的准实验研究设计。首次中风或TIA的患者有资格参加。在一年的随访期间,前瞻性地招募了干预组,并得到了病例经理的支持。最佳完全匹配用于基于法定索赔数据生成控制组。主要结果是卒中复发。使用Cox回归分析复发和死亡率;其他次要结果使用基于测试的程序和逻辑回归检查。此外,进行亚组分析.
结果:从2018年6月至2020年3月,干预组纳入了1,512例患者。已传输了19,104名患者的索赔数据,以建立对照组。在匹配过程之后,每组1,167例患者纳入分析。干预组复发70例(6.0%),对照组复发67例(5.7%)。风险比为1.06(95%CI:[1.42-0.69];p=0.69),对主要结局无显著影响.关于次要结果死亡率,干预组死亡36例,对照组死亡46例(3.1%vs.3.9%)。再一次,无显著影响(HR:0.86;95%CI:[0.58-1.28],p=0.46)。
结论:根据目前的发现,此处评估的卒中患者病例管理方法无法证明医疗保健有所改善.病例管理的潜在影响可能无法在短时间内得到充分描述。因此,未来的研究应该考虑更长的观察期.
结论:专家小组应讨论支持成本密集型个体病例的病例管理的核心方法是否与对卒中患者进行一刀切的干预的广泛实施相反。在这种情况下,进一步的研究应该集中在更具体的研究人群上。
BACKGROUND: Patients with initial stroke or transient ischemic attack (TIA) are at high risk for further strokes, death or cardiovascular events. Even the first-ever stroke is associated with a high chance of disability and need for assistance. The risk of long-term health care demands increases with each subsequent event. Although the inpatient sector already provides a high standard of care in Germany, it can be difficult to obtain cross-sectoral aftercare. Thus, the study investigated whether a structured
case management program can avoid stroke recurrences.
METHODS: The study was conducted with a quasi-experimental study design in three regions in North Rhine-Westphalia. Patients with first-ever stroke or TIA were eligible to participate. The intervention group was prospectively recruited and supported by a
case manager during a one-year follow-up. Optimal Full Matching was used to generate a control group based on statutory claims data. The primary outcome was the stroke recurrence. Recurrence and mortality were analysed by using Cox regression; other secondary outcomes were examined with test-based procedures and with logistic regressions. Additionally, subgroup analyses were performed.
RESULTS: From June 2018 to March 2020, 1,512 patients were enrolled in the intervention group. Claims data from 19,104 patients have been transmitted for establishing the control group. After the matching process, 1,167 patients of each group were included in the analysis. 70 recurrences (6.0%) occurred in the intervention group and 67 recurrences (5.7%) in the control group. With a hazard ratio of 1.06 (95% CI: [1.42-0.69]; p=0.69), no significant effect was found for the primary outcome. With regard to the secondary outcome mortality, 36 patients in the intervention group and 46 in the control group died (3.1% vs. 3.9%). Again, there was no significant effect (HR: 0.86; 95% CI: [0.58-1.28], p=0.46).
CONCLUSIONS: Based on the present findings, the case management approach for stroke patients evaluated here was unable to demonstrate an improvement in health care. Potential effects of
case management might not be adequately depicted in short observation periods. Thus, future studies should consider longer observation periods.
CONCLUSIONS: A panel of experts should discuss whether the core approach of
case management to support cost-intensive individual cases is contrary to a broad implementation with a one-size-fits-all intervention for stroke patients. In this
case, further research should focus on more specific study populations.