Researcher ORCID Identifier

0009-0007-2315-217X

Graduation Year

2026

Document Type

Campus Only Senior Thesis

Degree Name

Bachelor of Arts

Department

Biology

Reader 1

Benjamin Schlau

Reader 2

Sadie Otte

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2025 Zoë S Molenkamp

Abstract

Ischemic stroke remains a leading cause of disability and death in the United States and disproportionately impacts medically underserved and socially vulnerable populations. Individuals experiencing unsheltered homelessness face particularly elevated risk for ischemic stroke, both because high-risk demographic groups are overrepresented in the population and because they experience unique structural barriers to healthcare. Although housed and unhoused patients have comparable in-hospital outcomes when appropriate acute treatment is delivered, unhoused patients exhibit worse functional outcomes and increased rates of rehospitalization and secondary stroke after discharge. Post-discharge guidelines recommend consistent primary care engagement following ischemic stroke to support recovery and prevent recurrence, with added emphasis on timely care during the critical 90-day period after discharge. For unhoused patients, however, receiving necessary care outside the hospital is often unattainable, causing outcome disparities to re-emerge. Therefore, expanding access to primary care models that sustain care continuity for unsheltered ischemic stroke survivors is essential. This study proposes a multi-site prospective observational study of unsheltered ischemic stroke survivors discharged from comprehensive stroke centers with affiliated dedicated primary care programs. The study will evaluate two models specifically designed to bridge gaps in healthcare for the unhoused, dedicated primary care clinics and Street Medicine programs. By comparing outcomes between patients who engage with these services and those who do not, the study will evaluate how these models impact stroke recurrence, rehospitalization and functional outcomes in the 90-days following hospital discharge. The outcomes will be analyzed based on electronic health records and modified Rankin Scale data collected during the study period. This research will address critical gaps in literature and stroke care by investigating the efficacy of dedicated primary care models for improving outcomes in unhoused ischemic stroke survivors. The evidence generated by this study aims to improve care continuity for unsheltered ischemic stroke patients and inform healthcare policy that expands primary care access for the broader unhoused population.

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