Stroke Care Transitions Program Benefits from Social Work Case Managers
When social workers helped stroke patients and their caregivers transition from the hospital to home, these case managers found some anecdotal benefits over a 90-day period.1
Compared with usual care, the case management intervention in the Michigan Stroke Transitions Trial (MISTT) did not show a difference between usual care and the intervention groups. It did not produce the quantitative benefits of perceived caregiver changes in social functioning, subjective well-being, and physical health resulting from their role as caregivers.
The lack of measurable differences between the intervention group and the usual transitions of care group could be partly related to the short time frame of the study, says Amanda T. Woodward, PhD, lead study author and professor, MSW program director, and associate director for academic affairs in the School of Social Work at Michigan State University.
“We learned that it’s a very challenging period in terms of getting home health set up, and physical therapy and occupational therapy,” Woodward explains. “While, anecdotally, patients and caregivers talked a lot about how helpful case management was, it wasn’t enough to influence these quantitative measures the randomized trial was focused on.”
On average, caregivers tended to be healthy, so there was not a lot of room for improvement in the measures researchers were assessing.
“We know from other literature that the nature of stroke and the effects of stroke are so variable by individual and so variable over time that if we were able to collect data farther out, we might see some more effect,” Woodward says.
Woodward and colleagues focused on what happens when stroke patients and their caregivers are transitioned home. In addition to a standard care group and an intervention group, a third group of people received a social worker case manager and online access to additional stroke education.
“We did a home visit, biopsychosocial assessments, and weekly check-ins at the minimum, and mostly by phone,” Woodward says.
Woodward and colleagues found usage of the stroke education site was low. “We know anecdotally and from my reading of the case notes that patients sometimes used the website, but it was more often caregivers accessing it on behalf of patients or using it for their own information,” she explains. “But website use was pretty low overall.”
The usual care group received each hospital’s standardized care follow-up after discharge. “We mailed them information parallel to some things available on the website,” Woodward says. “It was more from the perspective to keep them engaged to do a 90-day data collection.”
The intervention groups received hands-on support and assistance with financial barriers, connecting with mental health counseling, medication education, and organization.
“Depending on patients’ needs and goals, case managers helped with things that are not strictly in the medical realm of need,” Woodward says.
These included helping patients and caregivers organize their medications with pill boxes, talking them through stress management techniques, and connecting families with loan closets, which could provide a walker or shower care equipment at no cost. Loan closets provide no-fee medical equipment and supplies that people return when they no longer need them.
Case managers might refer people to support groups and help them locate transportation services for medical appointments.
“They helped them prepare for doctors’ appointments, asking what kind of questions they want to ask and helping them write those down,” Woodward explains.
Social worker case managers also helped patients call the state department of health and human services and organizations that could help with food or utility bills.
“Sometimes, case managers worked more with patients; other times, it was more support for the caregiver,” Woodward says. “Caregivers would get frustrated, and they provided a supportive ear for that.”
For instance, the case manager would ask the caregiver what they needed to know about the patient’s illness and experience.
“They helped normalize what they were experiencing and what the patient was going through,” Woodward explains. “There was a lot of problem-solving and emotional support for patients and caregivers.”
Some patients experienced issues with housing before the stroke. The illness magnified their physical challenges.
“The intervention was intended to be very patient-centered. The initial assessment and goals they identified were patient-centered, patient-driven,” Woodward says. “Even if their goals were not necessarily the goals the doctor had set, like quitting smoking, the social worker case manager provided support of the patient’s identified goals.”
In an earlier paper involving the MISTT patients, investigators found patients who received the social worker case management intervention and the online stroke education showed significantly greater gains in patient-reported physical health and activation when compared with usual care or case management alone.2
“This was one of the interesting things from the research: The group that had access to the website had higher scores for physical health outcomes than the other groups,” Woodward says. “Even though use of the website was limited, they still had better outcomes than some other groups.”
Despite the results of one group receiving case management services, Woodward believes in the importance of case management from a quality of life perspective.
“The challenges that these folks faced when they got home were so vast and beyond just medical outcomes from stroke,” Woodward explains. “Many people were struggling before they had a stroke because of low income, housing issues, and mental health challenges. These were exacerbated by the experience of the stroke.”
Stroke patients might have lost their ability to work and had to face new challenges in all areas of their lives.
“The consequences of stroke — finances, housing, food, family, relationships — that’s what social work case management is all about,” Woodward says. “It’s the biopsychosocial piece connecting all of these other pieces.”
REFERENCES
- Woodward AT, Fritz MC, Hughes AK, et al. Effect of transitional care stroke case management interventions on caregiver outcomes: The MISTT randomized trial. Soc Work Health Care 2021 Dec 22;1-14.
- Reeves MJ, Fritz MC, Woodward AT, et al. Michigan Stroke Transitions Trial. Circ Cardiovasc Qual Outcomes 2019;12:e005493.
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