Towards a Distinct Experience and Optimum Quality of Life
BY SULTANAH AL HARBI, MOHAMED AHMED, MOHAMMED AL ALTHOBAITI, AHMED NEWERA, FRENK LEE BALDOVINO, KAMILLE BIANCA RAVIZ, LEO MEDALLA, HADEEL AL TALHI
2024 Case Management Practice Improvement Award Recipient through the CMSA Foundation
Stroke, a sudden, devastating event that can leave individuals with life-altering disabilities. The impact extends far beyond the survivor, affecting families, communities, and healthcare systems worldwide. But what if recovery could be dramatically improved, leading to a significantly higher quality of life? At Al Hada Armed Forces Hospital in Taif, Saudi Arabia, a groundbreaking case management program is not only achieving this but also offering a powerful, replicable model for global healthcare.
For years, stroke recovery has been hampered by a complex interplay of factors: fragmented care, inconsistent treatment protocols, a lack of patient-centered approaches, and inadequate integration of support systems. Al Hada’s innovative program directly addresses these challenges, delivering remarkable results that are transforming the landscape of stroke care and inspiring a new era of patient-focused rehabilitation.
THE GLOBAL AND NATIONAL BURDEN OF STROKE: A LOOMING CRISIS
Stroke, characterized by the rapid onset of focal or global cerebral dysfunction of vascular origin, remains a leading cause of death and long-term disability worldwide. Its impact is far-reaching, affecting not only survivors but also their families and caregivers, placing a substantial burden on healthcare systems and economies. The emotional and psychological toll is profound, often leading to feelings of isolation, anxiety, depression, and reduced quality of life (QoL).
In the Kingdom of Saudi Arabia, a nation experiencing rapid socioeconomic development and significant lifestyle changes, the incidence and prevalence of stroke are escalating. The prevalence of stroke is estimated at 43.8 per 100,000 individuals, with ischemic stroke being the most prevalent type. This high burden is projected to increase dramatically, with mortality rates expected to nearly double by 2030. Understanding the complex factors influencing QoL in stroke survivors and their caregivers is crucial for developing effective interventions and support systems. Sociodemographic characteristics, along with emotional, physical, and cognitive impairments, all play significant roles. This highlights the critical need for individualized, comprehensive care that addresses the unique needs of each patient and their support network.
PRE-INTERVENTION CHALLENGES: A CALL FOR CHANGE
Despite the early establishment of a stroke committee and a comprehensive stroke program at Al Hada Armed Forces Hospital, challenges in implementation led to suboptimal patient outcomes. Baseline data revealed a concerning situation:
- High Readmission Rates: In the first quarter of 2021, in-hospital readmission rates for post-stroke patients due to secondary strokes reached a concerning 6.2%.
- Poor Quality of Life: The average modified Rankin Scale (mRS) score, a widely used tool for assessing functional status after stroke, was 3.33, indicating a significantly impaired QoL.
These alarming figures highlighted the urgent need for intervention. A thorough analysis of contributing factors revealed three major areas requiring improvement:
- Lack of a Streamlined Care Pathway: The absence of a structured, integrated approach to stroke care resulted in fragmented services and delays in treatment.
- Limited Public Awareness: Insufficient public awareness regarding stroke symptoms and the importance of timely intervention hampered early diagnosis and treatment.
- Ineffective Benchmarking: The lack of a robust stroke registry hindered the effective monitoring of patient progress, identification of areas for improvement, and assessment of the program’s overall effectiveness.
These findings underscored the necessity for a comprehensive, multi-faceted intervention to address the gaps in resource utilization, service provision, and evidence-based care. The aim was to establish an intervention protocol integrating case management approaches into a standardized stroke care pathway, evaluating its effectiveness in improving QoL, patient satisfaction, and reducing stroke recurrence.
THE INNOVATIVE INTERVENTION: A PATIENT-CENTERED APPROACH TO STROKE RECOVERY
The intervention at Al Hada Armed Forces Hospital introduced a revolutionary, patient-centered approach to stroke recovery, focusing on five key strategies:
1. Comprehensive Stroke Pathway
A structured pathway was implemented, guiding patients through all phases of care, from initial diagnosis to long-term rehabilitation. This streamlined approach minimized delays, facilitated seamless transitions between care settings, and ensured that patients received timely and appropriate interventions at each stage of their recovery journey. Clear protocols and guidelines were established, ensuring consistency in care delivery and optimizing treatment efficacy.
2. Multidisciplinary Collaboration
A cornerstone of the program was the establishment of a highly collaborative multidisciplinary team. Neurologists, physiatrists, physical therapists, occupational therapists, speech-language pathologists, social workers, case managers, and nurses worked together to develop and implement individualized care plans tailored to each patient’s unique needs and goals. Regular team meetings were held to discuss patient progress, adjust treatment plans as needed, and ensure seamless coordination of care. This collaborative approach fostered a shared understanding of patient needs and ensured that all aspects of care were integrated and aligned.
3. Family Involvement and Empowerment
Recognizing the crucial role of family support in stroke recovery, the program actively involved family members in the care process. Educational sessions were provided to equip families with the knowledge and skills necessary to support their loved ones effectively at home. Counseling services were offered to address the emotional and psychological challenges faced by families, providing them with coping strategies and resources. This family-centered approach fostered a supportive environment and improved adherence to treatment plans.
4. Streamlined Service Coordination
The program emphasized the importance of coordinated care, ensuring that all services were aligned with the patient’s individual recovery goals. This involved establishing clear communication channels between different healthcare providers, minimizing redundancies, and improving the overall efficiency of care delivery. A dedicated case manager played a central role in coordinating services, ensuring timely access to resources, and facilitating smooth transitions between different care settings.
5. Patient-Centered Care
The program prioritized patient autonomy and choice. Regular feedback loops were established, allowing patients to express their concerns, preferences, and goals. This information was then incorporated into their treatment plans, ensuring that care was truly personalized and responsive to individual needs. This patient-centered approach fostered a sense of empowerment and improved patient satisfaction.
IMPACTFUL OUTCOMES: A TRANSFORMATION IN STROKE CARE
The results of Al Hada’s innovative program have been truly transformative. The intervention led to significant improvements across several key outcome measures:
Improved Functional Status: Patients experienced substantial improvements in their mRS scores, indicating enhanced neurological function and a marked increase in their ability to perform daily activities. The average mRS score decreased significantly, reflecting a substantial improvement in QoL.
Increased Patient Satisfaction: Patient satisfaction surged dramatically, rising from 45% to an impressive 94%. This significant increase reflects the program’s success in creating a supportive, effective, and patient-centered recovery environment. Patients reported feeling more empowered, understood, and supported throughout their recovery journey.
Reduced Readmission Rates: The program significantly reduced hospital readmission rates due to secondary strokes, dropping from 6.2% to 4%. This reduction underscores the program’s effectiveness in preventing further health complications and improving long-term outcomes. The decrease in readmissions also translates into significant cost savings for the healthcare system.
Cost-Effectiveness: The program demonstrated significant cost-effectiveness, with estimated savings per QALY gained. This highlights the program’s dual impact: improving patient outcomes while optimizing healthcare resource utilization. These cost savings are particularly important in the context of the increasing burden of stroke on healthcare systems worldwide.
A Global Model: Inspiring Change in Stroke Care Worldwide
Al Hada’s pioneering program sets a powerful precedent for stroke care worldwide. It demonstrates the profound impact of a well-orchestrated case management strategy, offering a replicable blueprint for healthcare practitioners globally. The program’s success lies not only in its innovative strategies but also in its commitment to patient-centered care, multidisciplinary collaboration, and family involvement. The program’s success highlights the importance of integrating evidence-based practices into a comprehensive, holistic approach to stroke recovery.
The program’s success offers several key lessons for other healthcare systems seeking to improve their stroke care:
- The importance of establishing a streamlined, integrated care pathway.
- The benefits of multidisciplinary collaboration and teamwork.
- The crucial role of family involvement and education.
- The need for patient-centered care that prioritizes individual needs and preferences.
- The importance of robust benchmarking and data collection to monitor progress and identify areas for improvement.
Al Hada’s experience serves as a powerful call to action for healthcare professionals worldwide. By embracing innovative, patient-centered approaches and fostering a culture of collaboration and continuous improvement, we can revolutionize stroke care and create a future where stroke survivors experience optimal recovery and a significantly improved quality of life. This is not merely a success story; it is a testament to the transformative power of a holistic, patient-focused approach to healthcare.
For more about this project and the CMPI Award recognition, visit www.cmsafoundation.org/2024CMPI
Sultanah Alharbi, BSN, RN, MHA, serves as regional director of case management with the Armed Forces Hospital Taif in Saudi Arabia. She brings more than a decade of expertise in both clinical bedside care and management. Her career is marked by a dedication to innovation, consistently seeking improvement to patient outcomes and experiences. In 2024, Sultanah’s team was recognized with the CMSA Foundation’s Case Management Practice Improvement Award, underscoring their impact on the field. Sultanah’s unique ability to integrate practical clinical insights with strategic management acumen has elevated patient care standards and set new benchmarks for innovative practices in healthcare.
Image credit: LEMAU STUDIO/SHUTTERSTOCK.COM
