Integrating Web-Based Resources and Social Work Case Management: Preliminary Results on Website Utilization from the Michigan Stroke Transitions Trial

Background and purpose: Stroke is an unexpected event with profound impact on many aspects of life.  Patients face physical, psychological, and emotional challenges, changes in roles and relationships, and financial strain. The Michigan Stroke Transitions Trial (MISTT) is an ongoing pragmatic trial testing a social work case management (SWCM) intervention during the first 60 days after returning home from the hospital.  Patients are randomized into one of three groups:  1) usual care, 2) SWCM, or 3) SWCM plus access to a curated website containing stroke specific information and resources.  This presentation will focus on preliminary descriptive data from subjects who have website access.  We describe the extent to which patients access the study website and how website use aligns with patient-identified recovery goals.

Methods: Patients are enrolled in the hospital and randomized when discharged home.  For those in groups 2 or 3, a social worker conducts a comprehensive biopsychosocial assessment and works with the patient to identify recovery goals.  For group 3 participants, social workers set up access to the website and provide an orientation.  The social worker maintains a minimum of weekly contact via phone, email, text, or home visit as needed for 60 days. Google Analytics is used to track website usage.  Data collected by the social worker throughout the intervention are entered into REDCap, a secure web application for building and managing online databases.  Thirty-three group 3 patients enrolled who had completed the intervention as of April 15, 2017 were included in analysis.  Number of unique visits to the website, specific pages viewed, and the dates of website access from Google Analytics were compared with REDCap data on patient goals, assessment dates, and timing of social worker interactions.

Results: Fifteen of the 33 patients accessed the website only once, twelve visited the website on two or three separate dates, and 6 visited four times or more.  About half of those with only one visit were on the website on or immediately following the day of the social worker assessment. Among those who visited the website more than once, at least one subsequent website visit corresponded to some form of contact with the social worker and for most of those the social worker referred the patient or caregiver to the website or used website resources during a home visit.  Among the more frequent users, the pages visited are clearly related to specific patient goals, for example visiting pages related to diet and having a goal related to eating healthier. In addition, more frequent users utilized the website search function to locate content specific to their goals such as “mobility”, “diabetes”, or “speech”.

Conclusion and implications:  While use of the MISTT study website is limited, two types of use emerge.  Social workers used the website as a tool to refer patients and caregivers to as well as when directly interacting with patients. Second is the targeted patient use over time by more frequent users.  These preliminary results suggest there is utility in such a targeted web-based resource.