About the Project

The Michigan Stroke Transitions Trial (MISTT) is a randomized clinical trial designed to help stroke patients and their caregivers after returning home from the hospital.

Approximately three quarters of stroke survivors return home, but for some this occurs after a complex series of transitions involving stays in rehabilitation and nursing care facilities, as well as repeat visits to the hospital.

For many stroke patients and caregivers, navigating the transition between the hospital and home is associated with substantial emotional, social, and health-related challenges. These challenges are intensified by the abrupt nature of stroke, the short in-hospital stay (typically <4 days), and the multiple care settings that patients may use after leaving the hospital which include rehabilitation and skilled nursing facilities, home health care, and outpatient care. Poor transitions for stroke patients often result in hospital readmissions, slow recovery, poor quality of life, dissatisfaction with care, and caregiver stress.

The goal of the MISTT study is to test the impact of the following two interventions:

  1. A Masters-level trained social work case manager who will work with stroke survivors and caregivers to develop a home based service plan, and
  2. A study website that provides information, resources, and links to services designed to support stroke survivors and caregivers during the transition period.

The MISTT study is designed as a pragmatic randomized clinical trial that is comparing the following 3 groups: usual care (group 1), social work case management (group 2), and a combination of social work case management plus access to the study website (group 3).

The Study is being conducted by a team of researchers at Michigan State University along with partners at the following 3 hospitals:

St. Joseph Mercy Hospital, Ann Arbor

St. Joseph Mercy Hospital, Ann Arbor

Sparrow Hospital, Lansing

Sparrow Hospital, Lansing

University of Michigan Hospital, Ann Arbor

University of Michigan Hospital, Ann Arbor

Who is funding the study?

The study is funded by an independent nonprofit organization called the Patient Centered Outcomes Research Institute (PCORI), which receives funding from the U.S. federal government.

Why is the study focused on transitions that occur after discharge from the hospital?

Due to the many challenges associated with recovering from stroke, patients and their caregivers often experience a great deal of stress and worry after returning home from the hospital. This stress and worry contribute to the problem of “poor transitions”, which are associated with slower recovery and poorer quality of life for both patients and caregivers. Over the last 2 years we have talked with several groups of stroke survivors and caregivers about their experiences after leaving the hospital following a stroke. Although individual experiences can vary widely, we found that the following problems were commonly reported by stroke patients and caregivers after they return home:

  1. Unprepared for the discharge back to home
  2. Poor understanding of the medications prescribed by their doctors
  3. Unsure of the cause of their stroke or how to prevent a second stroke
  4. Caregiver stress
  5. Need to access reliable information about stroke care and recovery