[Intersectoral coordination of complex chronic diseases: Evaluation of a project of stroke case managers in East Westphalia-Lippe].

Abstract

Stroke remains one of the leading causes of premature mortality or long-term disability. Hospital and rehabilitation treatment are meanwhile at a high level. Ensuring successful treatment and reducing the consequences can only be achieved with tailored long-term healthcare in the outpatient sector. The aim of the study described here was to prevent 30% of all stroke recurrences by implementing case management.The main evaluation of the intervention was conducted as a quasi-experimental study and was based on claims data. In addition, non-comparative analyses based on primary medical data and health-related quality of life as well as a process evaluation were carried out. All comparative outcomes were test-based. In addition, the three central outcomes of recurrence, mortality and costs were analyzed using regression methods. The primary data was analysed by using descriptive statistics. The process evaluation was carried out in a two-step process using qualitative expert interviews and a related quantitative questionnaire to measure physician acceptance.1,167 patients per intervention group (IG) and control group ( CG) were included in the final analysis. No significant influence of the intervention on the risk of stroke recurrence or mortality was determined (p>0.05). For the secondary outcome costs, the study groups differed significantly in favour of the controls (p<0.05). In addition, the IG had a significantly higher chance of receiving guideline-based secondary pharmaceutical prevention (p<0.05). The primary data indicated an increase in health-related quality of life over the study period. The physicians reported good integration of the stroke case managers into the care structures.A widespread adoption of the STROKE OWL intervention in standard healthcare cannot be recommended based on current findings. The results indicate that for successful integration into standard care, the study population should be selected more specifically and target groups that could particularly benefit from individual case management should be addressed in line with the core principle of case management.