Identifying Health Disparities and Health Services Gaps by Following Stroke Patient-Centered Care Needs: Preliminary Results from a Multi-Center Study -

Rachel Dankner ¹ David Orion ² Bella Gross ³ Galina Keigler ³ Itzhak Kimiagar ⁴ Gal Ifergane ⁵ David Tanne ⁶

¹Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
²Neurology, Sheba Medical Center, Ramat Gan, Israel
³Neurology, Galilee Medical Center, Nahariya, Israel
⁴Neurology, Assaf Harofeh Medical Center, Be'er Ya'akov, Israel
⁵Neurology, Soroka Medical Center, Beer Sheva, Israel
⁶Chair, The Israel Neurological Association, Israel

Objectives: To characterize stroke patient`s and his/her primary care-giver and family`s needs and expectations from the medical system, following an acute medical event involving hospitalization and community care treatment; to analyze the gaps between these needs and the actual care provided, emphasizing on population groups in the periphery and ethnic minorities.

Methods: In a multicenter prospective cohort study 800 acute stroke patients and about 400 primary caregivers hospitalized at 7 medical centers throughout Israel, are recruited. Personal details are recorded, and informed consent forms signed. Telephone-interviews are held 3-4 months, 8 months, and one year after acute hospitalization, to assess their functionality (Barthel index), coping with bureaucracy, availability and accessibility (financial and cultural), disease management, continuity of treatment, quality of life, anxiety and depression, cognitive function, and rehabilitation care received by the medical system.

Results: by now we have recruited ~210 patients and ~90 primary care-givers. Some have already completed 1-year follow-up and others are being followed. Preliminary results are showing that the patients` profiles resemble the total stroke patient population as presented in the 2014-15 National Stroke Registry, with mean age = 67.7±11.4 and 61% males. Risk factors profile is showing 55% with hypertension, 44% with dyslipidemia,31% with diabetes, 30% with cardiovascular morbidity, 20% with atrial-fibrillation, and 12% with previous stroke or TIA. Four months follow-up telephone interviews are showing 64% of patients were discharged home, 43% have symptoms of anxiety/depression, 53% with limited activity daily living (ADL) and 58% with pain/discomfort. A large proportion of patients report of needing more assistance and support in medical, social and financial excess needs after the stroke event.

Conclusions: Findings of the present study will enable decision makers to efficiently allocate resources and funds to needy populations, thus reducing gaps, reducing use of the medical system and reducing costs incurred by the system.