Michigan Stroke Transitions Trial

Summary

The Michigan Stroke Transitions Trial (MISTT) is a patient-centered randomized control trial that aims to improve the experience of stroke patients after they return home. The MISTT study will test the effect of two complementary interventions against usual care. The two interventions include: a) Stroke Case Managers (SCMs) who are trained social workers, and b) an online informational website or portal. The 12 week intervention period begins when the stroke patient returns home from the hospital or rehab facility. The SCMs will conduct at least 2 home visits with the patient (one within 3-4 days and one around 30 days) along with weekly follow-up telephone calls. Supplemental home visits will be used as necessary over the 12 week period. At the first home visit the social workers will conduct a comprehensive in-home assessment and link patients and caregivers to local resources as necessary. Patients also assigned to the website will have access to a patient-centered online information and support resource called the Virtual Stroke Support Portal (VSSP). The investigators hypothesize that this personalized case management program will reduce patient and caregiver needs, improve quality of life, and decrease caregiver stress. The MISTT study will enroll 315 acute stroke patients discharged from 3 Michigan hospitals and will be completed by the end of 2017.

Conditions

• Acute Stroke

Interventions

OTHER

SCM

One intervention (SCM) is provided. Stroke Case Managers (SCMs) will conduct 2 home visits; the first within 72-96 hours and the other after 30-days of returning home. SCMs will conduct weekly follow-up phone calls. Additional home visits are permitted if needed. Home visit activities include: 1. Biopsychosocial assessment of patient and caregiver needs. 2. Set up appointments. 3. Assist scheduling appointments with primary care physician and other medical providers. 4. Promote medication adherence through medication tool kits, pill organizers and other aids. 5. Facilitate patient and caregiver engagement and activation. 6. Facilitate access to social and community services.

OTHER

SCM and VSSP

SCM: Stroke Case Managers (SCMs) will conduct home visits at 72-96 hours and after 30-days. SCMs will conduct weekly follow-up phone calls. Additional home visits are permitted as needed. Activities include: 1. Biopsychosocial assessment of patient and caregiver needs. 2. Set up appointments. 3. Assist scheduling appointments with primary care physician and other medical providers. 4. Promote medication adherence through medication tool kits, pill organizers and other aids. 5. Facilitate patient and caregiver engagement and activation. 6. Facilitate access to social and community services. VSSP: Access and training on the Virtual Stroke Support Portal, an online information and support website which includes: 1. Contact list of care team members. 2. Access to hospital patient portal. 3. Stroke education materials, resources, and guidelines. 4. Access to Michigan 2-1-1 services. 5. Medication information and adherence tools. 6. Patient and Caregiver support networks.

Sponsors & Collaborators

• University of Michigan

  collaborator OTHER

• Trinity Health Michigan

  collaborator OTHER

• Sparrow Health System

  collaborator OTHER

• Massachusetts General Hospital

  collaborator OTHER

• Michigan State University

  lead OTHER

Principal Investigators

• Mathew J Reeves, BVSc, PhD · Professor, Department of Epidemiology and Biostatistics, College of Human Medicine

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2016-01-31

Primary Completion

2017-11-30

Completion

2017-11-30

Countries

• United States

Study Locations