Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial.
Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial.
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DOI：
10.1186/s13063-015-0605-5
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发表时间：
2015-03-15
期刊：
影响因子：
2.5
通讯作者：
Ogedegbe G
中科院分区：
文献类型：
--
作者：
Spruill TM;Williams O;Teresi JA;Lehrer S;Pezzin L;Waddy SP;Lazar RM;Williams SK;Jean-Louis G;Ravenell J;Penesetti S;Favate A;Flores J;Henry KA;Kleiman A;Levine SR;Sinert R;Smith TY;Stern M;Valsamis H;Ogedegbe G
黑人和西班牙裔中风幸存者的中风复发率高于白人。这种差异的部分原因是这些人群中不受控制的高血压比例过高。家庭血压远程监测（HBPTM）和护士病例管理（NCM）已被证明在解决血压（BP）控制和降低BP的多层次障碍方面有效。然而，这些干预措施的有效性尚未在中风患者中进行评估。本研究旨在评估这两种远程医疗干预措施在降低高血压不受控制的高风险黑人和西班牙裔中风幸存者的血压和复发性中风方面的比较有效性、成本效益和可持续性。共有450例近期非致残性卒中和不受控制的高血压的黑人和西班牙裔患者被随机分配到两种为期12个月的干预措施之一：1）HBPTM与初级保健提供者的无线反馈或2）HBPTM加个性化，文化定制，基于电话的NCM。患者从纽约市的健康和医院公司（HHC）网络内的中风中心和初级保健实践中招募。研究访视在基线、6、12和24个月时进行。主要结局是12个月时患者内收缩压的变化和24个月时卒中复发率。次要结局是12个月和24个月时干预措施的比较成本效益;探索性结局包括卒中危险因素、健康行为和治疗强化的变化。中风远程监测高血压试验的招募目前正在进行中。两种既定的有效干预措施的结合沿着卫生信息技术的利用，支持HBPTM + NCM干预措施的可持续性及其广泛实施的可行性。这项试验的结果将提供强有力的经验证据，为少数高血压不受控制的卒中幸存者的卒中管理提供临床指南。如果在黑人和西班牙裔中风幸存者中有效，这些干预措施有可能大大减轻中风复发的种族和民族差异。ClinicalTrials.gov NCT02011685。2013年12月10日注册。
Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension. A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing. The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence. ClinicalTrials.gov NCT02011685. Registered 10 December 2013.
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影响因子：
11.2
作者：
Cushman, Mary;Cantrell, Ronald A.;McClure, Leslie A.;Howard, George;Prineas, Ronald J.;Moy, Claudia S.;Temple, Ella M.;Howard, Virginia J.
通讯作者：
Howard, Virginia J.
影响因子：
8.3
作者：
Agarwal, Rajiv;Bills, Jennifer E.;Light, Robert P.
通讯作者：
Light, Robert P.
影响因子：
2.5
作者：
Artinian, Nancy T.;Flack, John M.;Fathy, Maryam
通讯作者：
Fathy, Maryam
DOI：
10.1136/bmj.c3995
发表时间：
2010-08-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Clark CE;Smith LF;Taylor RS;Campbell JL
通讯作者：
Campbell JL
影响因子：
8.3
作者：
Boden-Albala, Bernadette;Sacco, Ralph L.;Paik, Myunghee C.
通讯作者：
Paik, Myunghee C.