STRACK: VBHC Prize 2024 Nominee

STRACK, a three-year VBHC project led by Bellvitge University Hospital Spain, has set a precedent in
post-stroke patient care. Launched in May 2021, STRACK has evolved the continuum of care for more than 300
patients by integrating comprehensive monitoring of cardiometabolic risk factors (heart failure, diabetes,
atrial fibrillation, dyslipidemia, hypertension) into a patient discharge plan.
The first year included a thorough analysis of the current ways of working, the identification of improvement
areas, and designing new care pathways and ways of working for professionals. Patients were interviewed to
understand their point of view and to collect ideas for improvement. Afterwards, the digital platforms and
infrastructure were configured and deployed, and training was provided to over 150 staff.
Now, prior to discharge, patients receive a bespoke care plan, home monitoring devices, and access to a
digital platform for clinical data logging and telerehabilitation exercises. This holistic approach is supported
by asuite of digital tools that enhance patient-professional communication, facilitate real-time data sharing,
and enable proactive patient management through alerts and monitoring.