Effectiveness of an Integrated Clinical Management Strategy on Outcomes among Stroke Patients in Public Hospitals in Lake Region Counties, Kenya

Resumen

Context: The integrated clinical management strategy is a standardized, evidence-based approach that integrates assessment, interventions, and multidisciplinary care to optimize outcomes for stroke patients. Globally, stroke remains a leading cause of morbidity and mortality, often resulting in reduced quality of life, disabilities, and chronic complications. Effective, coordinated management is therefore essential to improving patient outcomes.

Aim: The study aimed to assess the effectiveness of an integrated clinical management strategy on outcomes among stroke patients in public hospitals in the Lake Region counties of Kenya.

Methods: This study employed a mixed-methods design with an experimental and a control group. A total of 173 stroke patients were recruited from four referral hospitals, with 87 assigned to the intervention group and 86 to the control group. Data were collected using a structured questionnaire, a key informant interview guide, and a health facility checklist. The research was conducted over a six-month period in the Lake Region Economic Bloc in western Kenya.

Results: Findings on length of hospital stay show that among those in the intervention group 48 (64%) stayed ≤8 compared to 27 (36%) of the control with a statistically significant difference between the two groups at p=0.002. Among participants who died, the intervention group had a total of 4 patients (4.6%), and the control group had 14 patients (16.3%) at p=0.01. Regarding return to pre-stroke functional state recovery, the intervention group had (n=68; 63%) compared to the control group that recorded (n=40; 37%) patients that returned to the pre-stroke state at p<0.0001.Overall, the effectiveness of the Integrated Clinical Management Strategy for stroke patients revealed a statistically significant difference between the study and control group at p=0.048 with a positive outcomes appearing among the stroke patients in the intervention group compared to control. Therefore, rejecting the null hypothesis. Qualitative findings revealed that factors such as timely presentation for treatment, stroke severity, age, and comorbidities influenced the effectiveness of integrated stroke care. Health facility factors, such as the availability of equipment, infrastructure, specialized units, the efficiency of the referral system, and institutional support, play a critical role, with well-resourced facilities achieving better patient outcomes overall.

Conclusion: The intervention significantly improved stroke patient outcomes, including reduced mortality, shorter hospital stays, fewer complications, and improved recovery. Patients in the intervention group were 1.4 times more likely to achieve a good outcome compared to those in the control group.