Education

Principal Illness Navigation: The Future of Post-Acute Stroke Care

Admin — Thu, 08 Aug 2024 04:30:00 GMT

By: Tailar Johnson, OTD, OTR/L | August 8, 2024

A stroke can have long–lasting impacts, with 90% of survivors reporting at least one stroke-related health complication that can be a barrier to recovery and lead to hospital readmission¹. With one of the highest rates of Emergency Department utilization, stroke is considered to be among the most expensive chronic conditions². The burden of stroke on both survivors and the healthcare system, coupled with many preventable post-stroke complications, underscores the need for post-acute support that improves quality of life, reduces subsequent stroke risk, and decreases unnecessary hospital readmissions.

Kandu Health was recently highlighted in a publication titled “Feasibility of a Telemedicine-Based Principal Illness Navigation (PIN) Service for Complex Populations Following Hospital Discharge After Acute Stroke” in Stroke Clinician³, the official journal of the Association of Neurovascular Clinicians. The article outlines the use of outpatient PIN services to provide stroke support and navigation to survivors and care partners after hospital discharge. These services provide individualized support, education, care coordination, and management of post-acute stroke in an effort to improve outcomes and decrease hospital readmissions. This feature highlights the possible value and benefit of navigation services for better management and care of stroke survivors. Despite changes to reimbursement, including Centers for Medicare and Medicaid Services (CMS) coverage for PIN services and an increasing body of literature highlighting the need for post-acute stroke navigation, Kandu Health’s services remain an exception rather than a standard of practice.

Anne Alexandrov, professor of Nursing and Neurology at UTHSC Memphis and Program Director of Net Smart, discusses practical implementation strategies for implementing post-stroke navigation services.

An Introduction to Principal Illness Navigation

Admin — Thu, 30 May 2024 04:15:00 GMT

Navigating the healthcare system after a stroke can be overwhelming for individuals and their loved ones. Many stroke survivors have no prior experience with similar situations and do not know how to ensure their best chances for recovery. With a variety of treatment options, specialists, and support services, it can be challenging for patients and their families to identify and access the right care. Medical jargon, complex treatment plans, and emotional stress add to the confusion.

In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced coding and coverage for Principal Illness Navigation (PIN) services. The CMS coverage of PIN services was developed based on decades of work in cancer navigation.¹ This work has shown that navigation services can help reduce health disparities and improve patient outcomes. It has also established standards for the ethics, qualifications, knowledge, skills, activities, and supervision of navigators.¹

Principal Illness Navigation services can be billed to health insurance for serious conditions, like stroke, that cause an increased risk of hospitalization, nursing home admission, or death. The goal is to provide survivors with holistic support and access to timely and coordinated care as they go through their journey towards recovery. Services included under PIN that can help survivors with the recovery process include:

Serving Diverse Stroke Populations

Admin — Wed, 28 Feb 2024 05:00:00 GMT

Eliminating Barriers to Recovery by Meeting Social Determinants of Health Needs
By: Lauren Sheehan, OTD, OTR/L

Recent advancements in treatments for stroke and improvements in overall systems of care have been instrumental in combating the increased incidence of stroke, which has moved from the third to the fifth leading cause of death in the United States¹. Despite these advancements, stroke remains a leading cause of adult disability. In addition, stroke survivors often demonstrate reduced compliance with the optimal plan of care due to shorter stays in acute care, hospital staffing shortages, and limited discharge planning resources².

The Impact of a Digital Platform in Stroke Recovery

Admin — Fri, 08 Dec 2023 05:00:00 GMT

Preliminary Outcomes from a Multi-Disciplinary Post-Acute Recovery Program
By: Nancey Trevanian Tsai, MD

This pilot study evaluates the outcomes of Kandu Health's survivor-centric, navigator-driven, digitally-enhanced platform supporting stroke survivors and their care partners during the post-acute recovery period. Each participant had weekly appointments with a designated clinical navigator, with the goal of reducing barriers to recovery, increasing health literacy and agency, as well as improving post-stroke quality of life.

Understanding Hospital Readmissions

Admin — Thu, 30 Nov 2023 05:00:00 GMT

Causes and timing of readmissions after discharge from stroke event
Summary of Data Presented by: Demetrius K. Lopes, MD and Shlee S. Song, MD, FAHA

The leading causes for readmission after stroke change significantly from the point of discharge to the patients’ 90-day milestone. This research highlights CMS retrospective data from over 230,000 Medicare Fee-for-Service (FFS) patients with an incident stroke in the year 2018, originally presented at the 2023 Society of Vascular and Interventional Neurology annual meeting by Dr. Lopes. The data uncovers breaking insights on the documented causes for readmission after stroke and the opportunity to reduce inpatient readmissions.