Hospital discharge for stroke patients: Transitional Care is Brain

Abstract Background Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy). Methods In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility). Results Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital. Conclusions Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients. Key messages • A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients. • Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.


Background:
At the University Medical Center Hamburg-Eppendorf (UKE), health care research has been established as one of five research priorities recommended by the Research Council with the founding of the Center for Health Care Research (CHCR) in 2006.The CHCR was involved in numerous research projects with the focus on strengthening regional networking.Despite the numerous initiatives, there is still potential for improvement with regard to a systematic and sustainable exchange in the region of Hamburg, Germany.Methods: These requirements led to the initiation of the 'Hamburg Network Health Services Research (HAM-NET)'.The mission of HAM-NET is to build an open forum for all relevant institutions, to concentrate their interests and needs in health services research and to promote and conduct innovative, efficient, needs-based and patient-centred health services research projects in the metropolitan area of Hamburg.Three main tasks were appointed: 1) linking health care research to relevant regional institutions, 2) promoting research activities and new fields of research and 3) using methodological expertise to promote young scientists.

Results:
By today 40 institutions from all sectors of health care joined HAM-NET.The regularly general meetings offer exchange and advice.Internal communication is promoted by mailing lists and newsletters.Also, HAM-NET presents itself with a website, logo and by organizing recurring events and participating in international and national congresses and networks.Within two funding phases a total of four overarching research projects were developed and implemented.Furthermore, a person with lived experience committee was established.

Conclusions:
For the further development of health care research as one the core disciplines of public health a regional network with an efficient infrastructure is needed.HAM-NET promotes this with the implementation of an innovative, efficient and Background: Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden.Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability.This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy).

Methods:
In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment.We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients.Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility).Results: Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%).The recanalization rate was 32% (150 on 464 ischemic stroke patients).Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities.About 8% (52 patients) of the overall sample died in hospital.

Conclusions:
Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional.Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients.

Key messages:
A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients.
Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.

DO Health promotion, Health literacy, Behavioural insights
Abstract citation ID: ckac131.313 The role of individual level health resources on health outcomes of newly settled migrants in Sweden

Background:
Structural barriers such as inadequate housing, lack of employment opportunities, and discrimination are known to adversely affect the health of newly settled refugee migrants.However, these barriers remain largely unresolved and unaddressed.Given the difficulties in addressing these structural barriers, there is therefore a need to better understand how individual level health resources, may influence health and mitigate ill health in the early post-migration phase.
The aim of this study was to explore the association between health and individual health resources such as health literacy, self-efficacy, emotional and practical social support in newly settled refugee migrants.

Methods:
The sample consisted of 600 Arabic speaking newly settled migrants with a refugee background, recruited from Swedish Civic Orientation program.The study questionnaire included measures on self-rated health, psychological well-being, health literacy, social support, and self-efficacy.

Results:
Multivariate binary logistic regression showed that limited health literacy, lack of emotional support, and low self-efficacy were consistently associated with poor health outcomes.Lack of practical support and demographic variables such as gender, education, and type of residence permit were not as imperative for the studied health outcomes.

Conclusions:
Individual level health resources may play an important role for the general and psychological well-being of newly settled migrants.Promoting health literacy in newly settled migrants and facilitating attainment of social support may not only positively influences their health in the often challenging establishment phase, but also enhance the prospects of later health and social integration.

Background:
VR FestLab is a newly developed simulated ''party'' where the player is being offered alcoholic beverages while steering their own party experience in virtual reality.We evaluated the efficacy of VR FestLab on drinking refusal self-efficacy of Danish male and female 15-18-year-old students and tested user satisfaction.Secondary outcomes were drug refusal skills, knowledge/awareness, communication skills, social support willingness, susceptibility to peer pressures, and outcome expectations.

Methods:
The intervention consisted of 15 minutes of gameplay and 30 minutes of group/in class discussion.The intervention group played VR FestLab where the control group played the VR game ''Oculus Quest -First Steps'' (no educational content).In a cluster-randomised controlled trial schools were randomly assigned to the intervention/control group.13 Danish schools were recruited containing 181 students in intervention/191 in control groups.Students completed a questionnaire before and immediately after the intervention.Data was analysed using mixed linear regression models.