AHA standards could address disparities in post-acute stroke care
A more uniform approach could lead to better care and patient outcomes.
The American Heart Association and American Stroke Association created Mission: Lifeline® Stroke to look at the entire system of stroke care to reduce barriers and eliminate gaps across settings.
To date, hospital systems in four states — Iowa, Montana, Nebraska and North Dakota — are participating in the program.
In 2022, the Stroke Post-Acute Care Standards were published, using the 2016 American Heart Association Stroke Rehabilitation and Recovery Guidelines as a reference. The idea was to emphasize the crucial role post-acute care plays in a patient’s recovery process.
Oluwole Awosika, MD, MSCR, said standards could be a key tool in addressing disparities and a lack of access in post-acute stroke care. Dr. Awosika will be among a panel of experts discussing the standards’ goals and other aspects of post-acute stroke care in the Wednesday session, American Heart Association’s Post-Acute Care Stroke Program Standards: Delivering Comprehensive Care Across the Continuum.
Dr. Awosika is associate professor in the Department of Neurology and Rehabilitation Medicine and co-director of the Neurorecovery Lab at the University of Cincinnati.
“Studies from the late to early 2000s suggest that there are racial and socioeconomic disparities in post-acute care disposition and outcomes,” Dr. Awosika said. “This program acknowledges these disparities and further advocates for a more data-driven and patient-centered approach to post-acute care decision making.”
Dr. Awosika encourages health care professionals to use these guidelines in their practices to help address some of these issues.
“Doing so will allow for a more systematic and less biased approach to medical and rehabilitation decision making,” he said, adding that the work shouldn’t stop there. “Most of what we know about disparities in post-acute care management and outcomes comes from studies in the past decade. More updated and large-scale studies to assess progress and identify the key drivers are needed. Since the publication of the AHA guidelines, many questions about their utilization and effectiveness remain unanswered. A more standardized approach to post-acute care management would help answer some of these questions and optimize the care we provide to stroke survivors and their families.”
Co-speaker Katharina Sunnerhagan, MD, said patient-centric goals are an important motivational factor in post-stroke recovery. She is professor of rehabilitation medicine at the Institute of Neuroscience and Physiology and head of the Clinical Neuroscience Department at The Sahlgrenska Academy in the University of Gothenburg in Sweden.
“It gives people the opportunity to compare their current capacity and ability with what they achieved when they reached the goal,” she said. “Goal-setting prior to going home can be used for earlier supported discharge. For example, use the Canadian Occupational Performance Measure to help the patient set goals. And for spasticity treatment, the goal attainment scale can help evaluate the individual goals and the accomplishment of the (treatment) unit since it allows different goals to be compared.”
Dr. Sunnerhagen said having standardized goals put forth in the AHA standards could benefit patients and physicians in a number of ways.
“Goals might lead to behavioral changes, improve the effects of the rehabilitation and create more time-efficient rehabilitation,” she said. “It’s possible to assess the effects and end actions when the goal is reached. It will also help promote communications within the team.”