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Evaluating the Implementation of High Intensity Home-Based Rehabilitation Following Stroke

Award Number: K01HS028529
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 04/01/2022
PERIOD OF PERFORMANCE END DATE: 12/31/2023

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Evaluating the Implementation of High Intensity Home-Based Rehabilitation Following Stroke - Project Summary Stroke is a highly prevalent condition that contributes to significant deficits in functional mobility, particularly in older adults. To address these deficits, post-acute rehabilitation is an evidence-based component of care. However, facility-based rehabilitation (i.e., in a skilled nursing or inpatient rehabilitation facility) is costly. If stroke patients can achieve the same outcomes in a high-intensity home-based rehabilitation (HIHR) approach as in these facilities, the relative value (outcomes/costs) would be greater. The effectiveness of such an approach has not been studied. Further, the implementation of a HIHR care model has not been examined in the US health system. The objectives of the proposed research are to identify barriers to initial HIHR efforts implementation in one health system and to understand its clinical effectiveness to inform subsequent improvement of the care model. A hybrid type 2 study design with a triangulated mixed methods approach will be used over two cycles of a learning health system research framework. Specific aims are to (1) explore barriers affecting the initial implementation of HIHR for stroke patients, (2) compare the effectiveness of HIHR to facility-based rehabilitation on improving patients' function, and (3) implement a refined HIHR model and re- examine its implementation and effectiveness. We hypothesize that clinical workflow challenges and patient/caregiver preferences will affect the outcomes with initial implementation and that patients' function at HIHR discharge will be at least equivalent to patients' function at facility discharge. We also hypothesize that improvements in implementation and effectiveness outcomes will be achieved by refining the HIHR model after learning from the evaluation of the initial model. These aims align well with the candidate's goal to become an independent learning health system researcher, with an emphasis on studying rehabilitation practice in health systems. Training aims are to (1) develop expertise in mixed methods research and its application to care delivery, (2) gain expertise in assessing implementation success of a health system innovation, (3) develop expertise in comparative effectiveness research using observational data, and (4) develop skills to engage with health system leaders and lead a learning health system research lab. These training aims will be accomplished via one-on-one mentorship with content experts and combination of local and national coursework. All scientific and training aims will be accomplished in an environment that includes a large integrated academic health system and a partner institution for didactic instruction. The expected outcome of this work is a description of the implementation and effectiveness outcomes for HIHR. This is an innovative approach for post-acute rehabilitation following stroke that does not currently exist in the US health system, but which may substantially affect the value of care that aims to improve patients' functional independence following stroke.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $140,184 )
2025	2025	DUKE UNIVERSITY	2200 W MAIN ST	DURHAM	NC	27705	DURHAM	USA	Research on Healthcare Costs, Quality and Outcomes	000	5	3/21/2025	NON-COMPETING CONTINUATION	$144,936
2025	2024	DUKE UNIVERSITY	2200 W MAIN ST	DURHAM	NC	27705	DURHAM	USA	Research on Healthcare Costs, Quality and Outcomes	001	4	6/27/2025	NON-COMPETING CONTINUATION	$0
2025	2023	THE CLEVELAND CLINIC FOUNDATION	9500 EUCLID AVE, NA4	CLEVELAND	OH	44195	CUYAHOGA	USA	Research on Healthcare Costs, Quality and Outcomes	002	2	7/1/2025	NON-COMPETING CONTINUATION	-$4,752
														Subtotal = $140,184

Issue Date FY: 2024 ( Subtotal = $146,663 )
2024	2024	DUKE UNIVERSITY	2200 W MAIN ST	DURHAM	NC	27705	DURHAM	USA	Research on Healthcare Costs, Quality and Outcomes	002	4	6/7/2024	NON-COMPETING CONTINUATION	$146,240
2024	2023	THE CLEVELAND CLINIC FOUNDATION	9500 EUCLID AVE	CLEVELAND	OH	44195	CUYAHOGA	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	2/5/2024	NON-COMPETING CONTINUATION	-$22,215
2024	2023	DUKE UNIVERSITY	2200 W MAIN ST	DURHAM	NC	27705	DURHAM	USA	Research on Healthcare Costs, Quality and Outcomes	001	3	2/5/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$22,638
														Subtotal = $146,663

Issue Date FY: 2023 ( Subtotal = $147,590 )
2023	2023	THE CLEVELAND CLINIC FOUNDATION	9500 EUCLID AVE	CLEVELAND	OH	44195	CUYAHOGA	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	3/23/2023	NON-COMPETING CONTINUATION	$147,590
														Subtotal = $147,590

Issue Date FY: 2022 ( Subtotal = $148,335 )
2022	2022	CLEVELAND CLINIC FOUNDATION, THE	9500 EUCLID AVE	CLEVELAND	OH	44195	CUYAHOGA	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	3/28/2022	NEW	$148,335
														Subtotal = $148,335

Grand Total All Awards = $582,772

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Evaluating the Implementation of High Intensity Home-Based Rehabilitation Following Stroke

Award Number: K01HS028529

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 04/01/2022

PERIOD OF PERFORMANCE END DATE: 12/31/2023

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