Structured Abstract

Contents

• Preface
• Acknowledgments
• Technical Expert Panel
• Peer Reviewers
• Executive Summary
• Introduction
  • Background
  • Scope and Key Questions
  • Purpose of This Report
  • Role of the Technical Expert Panel
• Methods
  • Analytic Framework
  • Literature Search Strategy
  • Process for Study Selection
  • Data Extraction and Data Management
  • Individual Study Quality Assessment
  • Data Synthesis
  • Grading the Body of Evidence for Each Key Question
  • Peer Review and Public Commentary
• Results
  • Literature Search and Screening
  • Key Question 1 For patients hospitalized with first or recurrent stroke or myocardial infarction (MI), what are the key components of transition of care services? Can these components be grouped in a taxonomy, and are they based on a particular theory?
  • Key Question 2 For patients hospitalized with first or recurrent stroke or MI, do transition of care services improve functional status and quality of life and reduce hospital readmission, morbidity, and mortality (up to 1 year postevent)?
  • Key Question 3 For patients hospitalized with first or recurrent stroke or MI, what are the associated risks, adverse events, or potential harms—both system-based and patient-based—of transition of care services?
  • Key Question 4 Do transition of care services improve aspects of systems of care for patients with stroke or MI (e.g., more efficient referrals, more timely appointments, better provider communication, reduced use of urgent care, or fewer emergency room visits as a result of transition of care services)? Is there improved coordination among multiple subspecialty care providers, and are new providers added to the care plan as a result of transition of care services?
  • Key Question 5 For patients hospitalized with first or recurrent stroke or MI, do benefits and harms of transition of care services vary by characteristics—both patient-based and system-based—such as disease etiology and severity, comorbidities, sociodemographic factors, training of the health care providers, participants (patients, caregivers), geography (rural/urban, regional variations), and insurance status?
• Summary and Discussion
  • Limitations of This Review
  • Conclusions
• Future Research
• References
• Abbreviations
• Appendixes
  • Appendix A Exact Search Strings
  • Appendix B Data Abstraction Elements
  • Appendix C List of Included Studies
  • Appendix D Quality and Applicability of Included Studies
  • Appendix E List of Excluded Studies

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10066-I, Prepared by: Duke Evidence-based Practice Center, Durham, North Carolina

Suggested citation:

Olson DM, Prvu Bettger J, Alexander KP, Kendrick AS, Irvine JR, Wing L, Coeytaux RR, Dolor RJ, Duncan PW, Graffagnino C. Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention. Evidence Report No. 202. (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-2007-10066-I.) AHRQ Publication No. 11(12)-E011. Rockville, MD. Agency for Healthcare Research and Quality. October 2011.

This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10066-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

1

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