Assistant Professor Amber Clark, M.D., received her second pilot grant from the Resource Centers for Minority and Aging Research (RCMAR) to study the post-stroke continuum among African American stroke survivors in Alabama.
Clark's study titled "Qualitative analysis of the post-stroke continuum among African American stroke survivors in Alabama” is aimed to identify any barriers patients and their caregivers experience once discharged back into the community. During the study, she will survey African American stroke survivors who are less than one-year post-stroke and greater than one-year post-stroke, in addition to conducting focus groups with caregivers in the cohort.
This population was chosen because African Americans have worse stroke outcomes and also lack proper transition of care. The goal is to get patients back to their community and improve their quality of life not just for them but also for their caregivers.
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Background
Background
Stroke is the second leading cause of disability in the world. African American (AA) patients are 50% more likely to have a stroke, and experience worse outcomes after a stroke event compared to White patients. Approximately two-thirds of individuals who suffer a stroke will survive and require rehabilitation after discharge from the acute care hospital setting. The transition of care (TOC) coordination in the post-stroke continuum of care for stroke survivors is severely lacking. In general, hospitals that serve mostly AA or Hispanic patients experience excessively high readmissions rates, even after taking the race/ethnicity of the patients into account. The post-stroke experience for AA patients contains challenges in navigating a complex medical system that can lead to financial, emotional, social, and physical demise. Establishing a robust and sustainable TOC process is crucial to decreasing readmissions to the hospital, improving quality of life, and balancing the cost of healthcare.
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Purpose of the study
Purpose of the study
The premise of this study is informed by our observational and practical clinical experience in caring for patients in both outpatient and acute care settings of stroke rehabilitation. Previous studies have explored the integration of transitional programs for adult stroke patients [5, 8]. However, the composition of the participants did not prioritize AAs. We have unique experience in working with AA populations and understand how they are disproportionally affected by stroke TOC in both acute and chronic settings. The University of Alabama at Birmingham (UAB) is an ideal location to do this work as we have the necessary infrastructure in place to conduct the proposed work. We have a community committed to improving care, a robust certified Comprehensive Stroke Center that treats greater than 1,800 strokes per year, are located in the deep south where disparities in this population are pervasive, and treat patients representing the entire state of Alabama. Approximately 37% of the population we provide TOC is AA. 61% of our patients are aged 45 years or greater and our 36-bed Neurosciences Intensive Care Unit is among the largest in the United States. Lastly, we are a major center for stroke research, have an integrated stroke recovery clinic and our inpatient rehabilitation facility ranks in the top 25 in the nation. Despite this infrastructure, there still is not a coordinated approach to address the needs of the AA community. As the stroke disparity in this community is already established, it is important to develop a TOC program that addresses the specific needs of this population and that reflects the true potential of our hospital system.
For this proposal, we will conduct one-time informational interviews to assess and understand the beliefs and barriers in the TOC among AA stroke survivors. We will enroll 20 AA stroke survivors from within UAB Health System via the acute neurology stroke service and the PI’s stroke recovery clinic. Recognizing that TOC experiences and perceptions evolve over time, participants will be recruited into 2 groups (10 AA participants each). The first group would include participants that are less than 1 year after their most recent stroke. The second group will include participants that are greater than or equal to 1 year out from their most recent stroke. We will use Zoom to record and transcribe the interviews and conduct a thematic analysis. Information will then be used to develop a unique TOC process in response to the distinctive needs and desires of this population. Results will also be shared with participants after study completion.
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Aims
Aims
Aim 1
Conduct structured informational interviews with 20 African American stroke survivors from urban and rural communities in Alabama to quantify knowledge, document attitudes, and beliefs, about post-stroke rehabilitation care (TOC).
Aim 2
Perform a thematic analysis to identify key strategies for improving their post-stroke care continuum experience and generate patient-informed suggestions and solutions using data collected in Aim 1.
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Impact
Impact
This project will serve as a feasibility study and provide a formative foundation for future TOC program development and implementation for African American stroke survivor populations.