UC Irvine

Purpose: This Quality Improvement project aimed to improve family caregiver support by individualizing support services and education guided by a caregiver preparedness assessment tool.Background: The caregiver's mental health and well-being are intimately linked with stroke survivors’ health outcomes and quality of life (Sutter-Leve et al., 2021). However, a systematic review of the literature has revealed that caregiver support interventions are small and inconsistent, despite the positive effects on caregiver efficacy, wellness, and health outcomes (Lopez-Hartmann et al., 2012). Design: The design of this project was a single-site, evidence-based project integrating recommendations from the literature and the American Heart Association’s Clinical Practice Guidelines for Adult Stroke Rehabilitation and Recovery (Winstein et al., 2016). PICO Question: Among stroke survivors and family caregivers discharging from a comprehensive stroke center, how can caregiver preparedness assessment in conjunction with a stroke survivor and caregiver support program, compared to usual care, influence discharge readiness and address gaps in caregiver readiness? Methods: Family caregivers of stroke survivors admitted to a 12-bed Neuro Intensive Care Unit or a 12-bed Neuro Progressive Care Unit at an academic medical center were given a caregiver assessment at hospital admission and discharge. Family caregivers were assessed utilizing the Preparedness for Caregiving Scale (PCS) of the Family Care Inventory. Family caregivers were given individualized interventions guided by their admission PCS scores. Throughout hospitalization, domains of need were communicated to the interdisciplinary care team via electronic medical record and displayed signs in the patient’s room. Discharge PCS scores were evaluated for efficacy of the intervention. Secondary outcome measures include care team surveys, anecdotal patient and family feedback, patient satisfaction scores, daily stroke education audits, and MyChart activation rates (patient portal). Results: PCS scores demonstrated improved caregiver readiness (p=0.00258). Dominant themes of mobility, communication, coping, caregiver stress, and help from the healthcare system continue to be areas of need, as reflected in the care team surveys and family caregivers’ responses. Patient satisfaction scores in communication, discharge, and care transitions were positively impacted during the project time frame. Conclusions: The interdisciplinary stroke team effectively identified family caregivers’ unmet needs and were addressed appropriately. This project highlighted the importance of family caregiver involvement in early education during a stroke survivors’ diagnosis and care. Future studies include refining how to operationalize a caregiver assessment tool within existing workflows to optimize resources, time allocation, and care coordination.