Cross-Cutting

Quality Improvement and Implementation Science

Stroke

Symposium

(602808) From Hospital to Home to Participation: Improving Transitions After Stroke

Presenter(s)

• 

  Marsha Neville, OT, PhD

  Professor
  Texas Woman's University
  Dallas, Texas
• 

  Kristine Miller, PT, PhD

  Associate Professor
  Indiana University
  Indianapolis, Indiana
• 

  Susan Lin, ScD, OTR/L, FAOTA

  Assistant Professor
  MGH Institute of Health Professions
  Round Hill, Virginia

This symposium reviews current evidence about transition planning in stroke rehabilitation focusing on the transition home and into the community within the framework of the Transitions of Care model. We will describe gaps in transition care, discuss barriers and facilitators for successful transitions, discuss and evaluate relevant assessments/tools, and provide recommendations to improve care coordination for persons with stroke from hospital to home and community. The integral role of the caregiver and accessing resources in the community will be emphasized. Attendees' perspectives will be sought throughout since organizations and communities may differ in their transition process and resources.

Learning Objectives:

• Analyze current practice guidelines and evidence for managing transitions in care
• Reflect on gaps in implementation of transitions of care management programs
• Evaluate recommendations for improving transitions of care based on the theoretical framework related to coordination for persons with stroke from hospital to home