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Evaluation

Clinical Session Proposals

Advancing PM&R Bold

Session Name: Concurrent Sessions

1301 - Transitioning to Value-Based Stroke Care

Thursday, November 16, 2023
2:15 PM – 3:30 PM CT
Location: CC 208-210
In-Person On Demand

    Session Director(s)

  • Sara Cuccurullo, MD

    Professor, Chair, Residency Program Director-Rutgers RWJMS & HMSOM, Medical Director and VP
    JFK Johnson Rehabilitation Institute PM&R Program
    Edison, New Jersey

    Disclosure(s): springer publishing: Royalties (Ongoing)

  • Talya K. Fleming, MD (she/her/hers)

    Assoc Prof: Hackensack Meridian SOM, Rutgers-RWJMS; Medical Director: Stroke Recovery Program
    JFK Johnson Rehabilitation Institute, Hackensack Meridian Health
    Edison, New Jersey

    Disclosure(s): American Heart Association, Volunteer Speaker's Bureau: Consultant/Advisory Board (Ongoing); NeuroTechR3, Volunteer Advisory Board: Consultant/Advisory Board (Ongoing); NuStep, Co-Principal Investigator-research grant awarded to institution: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Terminated, October 31, 2021)

Underlying vascular disease is common in both cardiac disease, peripheral vascular disease, and cerebrovascular disease (stroke). Acknowledging comparable risk factors as patients with cardiac disease, we expanded the cardiac rehabilitation model to benefit stroke survivors. The comprehensive outpatient Stroke Recovery Program is an innovative program, part of the Stroke-HEART™ Trials. In addition to the physical, occupational, and speech therapy traditionally delivered to stroke patients, this innovative approach is modeled after a traditional cardiac rehabilitation program and regular follow-up visits with a Physical Medicine and Rehabilitation physician in coordination with the patient’s Cardiologist. Subgroup analysis showed the Stroke Recovery Program to have reductions in 1-year all-cause mortality, a reduction in 1-year all-cause hospital readmission rate leading to cost savings, and improvement in overall function. These studies support emerging evidence that cardiac rehabilitation improves the lives of stroke survivors. This innovation in the healthcare delivery model improves access to value-based stroke care. Future research in this area may shift support to change public policy nationwide.

Changes in the healthcare system are in progress, and PM&R physicians should be at the forefront of change. Stroke is a chronic condition and one of the leading causes of adult disability in the world. While post-stroke care is projected to cost over $240 Billion US dollars by the year 2030, it provides an opportunity to reimagine a different approach to traditional stroke rehabilitation. Medical providers and organizations have been challenged to adapt healthcare interventions to deliver quality care, improve outcomes, and reduce costs.

Learning Objectives:

  • Compare the medical and rehabilitation similarities between stroke and cardiac disease.
  • Demonstrate how a value-based stroke care Stroke Recovery Program modifies a proven model used in cardiac rehabilitation to improve function, mortality, hospital readmission, and healthcare-related costs for stroke survivors.
  • Illustrate that stroke post-acute care deserves the same nationally supported healthcare delivery options that are effective for patients with other vascular diseases (e.g., cardiac rehabilitation, and supervised exercise training).
  • Propose that coordinated value-based stroke care can enhance quality care, improve functional outcomes, and reduce costs.