Department of Veteran Affairs (VA) Health Services Research & Development (HSR&D) Center of Excellence on Implementing Evidence-Based Practice (CIEBP).
J Multidiscip Healthc. 2011 Apr 28;4:111-8. doi: 10.2147/JMDH.S17154.
Managing cerebrovascular risk factors is complex and difficult. The objective of this program evaluation was to assess the effectiveness of an outpatient Multidisciplinary Stroke Clinic model for the clinical management of veterans with cerebrovascular disease or cerebrovascular risk factors.
The Multidisciplinary Stroke Clinic provided care to veterans with cerebrovascular disease during a one-half day clinic visit with interdisciplinary evaluations and feedback from nursing, health psychology, rehabilitation medicine, internal medicine, and neurology. We conducted a program evaluation of the clinic by assessing clinical care outcomes, patient satisfaction, provider satisfaction, and costs.
We evaluated the care and outcomes of the first consecutive 162 patients who were cared for in the clinic. Patients had as many as six clinic visits. Systolic and diastolic blood pressure decreased: 137.2 ± 22.0 mm Hg versus 128.6 ± 19.8 mm Hg, P = 0.007 and 77.9 ± 14.8 mm Hg versus 72.0 ± 10.2 mm Hg, P = 0.004, respectively as did low-density lipoprotein (LDL)-cholesterol (101.9 ± 23.1 mg/dL versus 80.6 ± 25.0 mg/dL, P = 0.001). All patients had at least one major change recommended in their care management. Both patients and providers reported high satisfaction levels with the clinic. Veterans with stroke who were cared for in the clinic had similar or lower costs than veterans with stroke who were cared for elsewhere.
A Multidisciplinary Stroke Clinic model provides incremental improvement in quality of care for complex patients with cerebrovascular disease at costs that are comparable to usual post-stroke care.
管理脑血管危险因素较为复杂且困难。本项目评估的目的是评估多学科卒中诊所模式在管理脑血管疾病或脑血管危险因素的退伍军人患者中的临床效果。
多学科卒中诊所通过半天的诊所就诊，为患有脑血管疾病的退伍军人提供护理，提供护理、健康心理学、康复医学、内科和神经病学等多学科评估和反馈。我们通过评估临床护理结果、患者满意度、提供者满意度和成本来对该诊所进行项目评估。
我们评估了在诊所接受治疗的前 162 名连续患者的护理和结局。患者最多进行了 6 次就诊。收缩压和舒张压分别下降：137.2 ± 22.0 mmHg 比 128.6 ± 19.8 mmHg，P = 0.007 和 77.9 ± 14.8 mmHg 比 72.0 ± 10.2 mmHg，P = 0.004，低密度脂蛋白（LDL）-胆固醇（101.9 ± 23.1 mg/dL 比 80.6 ± 25.0 mg/dL，P = 0.001）也分别降低。所有患者的护理管理中至少有一项主要建议发生改变。患者和提供者均对该诊所表示高度满意。在该诊所接受治疗的卒中患者的成本与在其他地方接受治疗的卒中患者相似或更低。
多学科卒中诊所模式在成本相当的情况下，为患有脑血管疾病的复杂患者提供了更好的护理质量，增量改善。
