Outcomes of an integrated clinical management strategy and associated factors for stroke patients in public hospitals in the lake region counties of Kenya

Abstract

Stroke is a major cause of mortality, morbidity, and diminished quality of life, making effective management essential for improving patient outcomes. An integrated clinical management strategy offers a standardized, evidence-based framework that combines comprehensive assessment, targeted interventions, and coordinated multidisciplinary care to enhance recovery among stroke patients. This study aimed to evaluate the outcomes of such a strategy and its associated factors among stroke patients in public hospitals in the Lake Region counties of Kenya. The target population comprised all patients admitted to the designated hospitals with a diagnosis of stroke. A quasi-experimental research design was used, enrolling 173 stroke patients from four county referral hospitals. Of these, 87 patients were assigned to the intervention group (in two hospitals), while 86 were in the control group (in two hospitals). The intervention group received care guided by an integrated clinical management strategy in addition to routine care. This strategy involved incorporating a structured tool into patient files and initiating care based on its guidelines. It was implemented by a nurse-led multidisciplinary team and emphasized coordinated, evidence-based care during hospitalization and after discharge through outpatient follow-up. The control group received standard stroke care. Data were collected using questionnaires, facility checklists, and patient records after obtaining institutional approvals. Healthcare providers and research assistants were trained on the integrated strategy. Patient outcomes, including mortality, hospital stay, morbidity, and complications, were recorded. The intervention was monitored through monthly reviews for up to six months, and discharged patients were followed up in outpatient clinics to assess progress. Data analysis was done using inferential and descriptive statistics. Findings showed that 43.3% (n=75) of patients had hospital stays of 1–7 days, while only 1.7% (n=3) stayed longer than 60 days. Mortality was significantly lower in the intervention group at 4.6% (n=4) compared to 16.3% (n=14) in the control group. Overall mortality was 10.4% (n=18), with most deaths (33.3%, n=6) occurring within 8–14 days of admission. Functional recovery was notably higher in the intervention group at 81.9% (n=68) compared to 55.6% (n=40) in the control group. Complications affected 72.3% (n=125) of patients. The most common were urinary incontinence (50.4%, n=63), pressure ulcers (38.4%, n=48), and aspiration pneumonia (33.6%, n=42), while depression was least reported (18.4%, n=18). The intervention significantly improved outcomes: patients in the intervention group were 70% more likely to have shorter hospital stays (RR = 1.7, 95% CI: 1.2–2.4, p = 0.002) and had a 72% lower risk of death (RR = 0.28, 95% CI: 0.10–0.78, p = 0.01). They were also 1.9 times more likely to return to pre-stroke functional status (RR = 1.9, 95% CI: 1.4–2.6, p < 0.0001) and 1.4 times more likely to achieve overall good outcomes. In conclusion, the integrated clinical management strategy significantly improved stroke outcomes, including survival, functional recovery, and reduced hospital stay. The study also found that stroke type and severity are associated, with hemorrhagic strokes presenting more severely. It recommends early diagnosis, timely intervention, and strengthened prevention strategies. Additionally, integrating patient, provider, and facility factors into stroke care is essential for improving recovery outcomes and adherence to secondary prevention.