Abstract TP28: Stroke Care Doesn't End At Hospital Discharge: What Patients Need After Hospital Discharge May Not Always Be Obvious (original) (raw)

Stroke, 2022

Abstract

Introduction: Mood disorders after stroke are common, with up to one-third of patients developing depression and/or anxiety. Identifying those at greatest risk may be challenging in the acute care setting. We sought to better understand post-hospital barriers impacting emotional well-being for those who suffered a stroke and to evaluate needs for additional resources post hospital discharge. Methods: A Stroke Transitional Care Program (STCP) was initiated at a large two-campus hospital in Southern California in October 2020. All patients discharged home with acute ischemic stroke (AIS), hemorrhagic stroke (HS), and transient ischemic attack (TIA) received a follow-up phone within 3-7 days of hospital discharge from a community health worker familiar with the community and language. An initial needs assessment was completed over the phone to evaluate barriers for post-hospital care, address social and economic needs, and help patients navigate the healthcare system. Data from the ini...

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