Help Patients Navigate Stroke & Recovery.

• 795,000¹

  Strokes in the U.S. each year

• Nearly 1 in 4¹

  Strokes that happen to someone who has already had one

• 12.1%⁶

  Ischemic stroke patients readmitted within 30 days

1. 1

   The Problem

   More than 795,000 people in the U.S. have a stroke each year, and nearly 1 in 4 of those strokes happens to someone who has had one before. In a North Carolina program, many patients seen within two weeks of discharge still had gaps: 36% did not recognize blood pressure as a stroke risk factor and 19% were not taking medicines as prescribed.^1,2

2. 2

   The Cost to Care Teams

   Medicare's transitional care rules ask teams to reach each patient within 2 business days, see them within 7 to 14 days, and handle education, medication adherence and community referrals in between. That work is hard to staff. In a statewide North Carolina trial, 61% of hospitals that declined to join cited insufficient staff or financial resources, and only 24% of enrolled patients received the full billable follow-up.^3,4,5

3. 3

   When Stroke Recovery Isn't Managed

   About 12% of ischemic stroke patients are readmitted within 30 days, and more than 20% of those readmissions are for acute cerebrovascular problems such as another stroke. About one third of survivors develop post-stroke depression, which is linked to higher risk of recurrent vascular events, poor quality of life and death. Stroke outcomes are public, too: CMS includes a hospital 30-day stroke mortality measure in its public reporting on Care Compare.^6,7,8

4. 4

   What Better Management Does

   A Cochrane review of 14 trials found that stroke self-management programs improved quality of life and confidence. Organized follow-up models gave patients 44% higher odds of reaching blood pressure targets, while education alone did not change risk factors. At one academic center, patients who attended a nurse-led transitional stroke clinic had about half the odds of a 30-day readmission. These findings concern staffed stroke programs, not PATHS. A Path could connect the team's education and agreed next steps for patients and caregivers.^9,10,11

• Daily Activities Path

  Denise can revisit the safe movement and daily tasks her rehabilitation team chose whenever she needs them. The steps patients revisit most show where the guidance can be clearer.

• Stroke Warning Signs Path

  Denise and her support person practice recognizing new stroke symptoms. Knowledge checks show the team which warning signs need clearer teaching.

• Rehab and Follow-up Path

  Denise finds her rehabilitation contacts and appointments in one place. Knowing where patients get stuck helps the team keep more of them connected to rehab.

The more the health system knows about each patient's experience and journey, the better it can make its workflows. What Denise and every other patient engage with, understand and ask about becomes health system intelligence: the team learns from every patient and refines each Path, so the next patient's experience is better. Clearer Paths mean fewer repeat calls and less time re-teaching the same education, and that saves time and money across the health system.