Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL)

项目概要： 高血压是缺血性和出血性卒中最重要的危险因素， 卒中后血压（BP）与卒中复发风险降低相关1 -4。然而，对于大多数 对于中风幸存者（SS），高血压在中风后早期仍然控制不佳。 美国，黑人和西班牙裔SS更有可能在卒中后有控制不良的危险因素， 与白色SS相比，白色SS、黑人和西班牙裔SS的卒中复发率更高。5 -11既往 在党卫军中减少血压控制种族差异的努力一直没有取得成功。 包括多学科方法的多组分护理模式显示出改善风险因素的希望 13，14健康的社会决定因素（SDOH）有助于解释BP控制的种族差异 因此，针对SDOH的多学科卒中后护理模式可能是关键， 降低血压控制的差异。5，7，15卒中后门诊治疗的有限性有助于 在开发系统级干预中风后BP控制的挑战。远程医疗和 远程监护可能是改善SS患者获得护理的理想方法。2019冠状病毒病疫情导致 远程医疗在中风幸存者急性期后护理中的快速扩展;然而，其有效性 未经证实基于我们中心的初步数据，我们提出了一项随机试验， 多学科远程医疗干预，基于视频的干预，以减少治疗和结局 最近出院的SS患者中卒中或短暂性脑缺血发作（虚拟）成人的差异 因缺血性卒中、出血性卒中或短暂性脑缺血发作住院治疗后回家。的 干预措施将包括由多学科小组进行的出院后远程保健访问，社会风险评估， 促进针对社会风险和社会风险知情的护理，以及家庭BP远程监测和管理。的 护理团队包括神经病学提供者（医生和执业护士）、药剂师和社会工作者。 标准治疗将包括神经科医生和初级保健提供者的随访以及药剂师辅助的BP 加强结构性改革我们的目的是评估1）干预对中风后6个月血压控制的影响 通过动态血压监测进行评估; 2）干预对1年内复发血管事件的影响 干预对卒中后卫生服务获得和利用的影响; 人种/种族对干预措施对血压控制、血管事件的影响的调节作用，以及 卫生服务利用; 5）额外测量的SDOH与小学和中学之间的关系 结果。

Project Summary: Hypertension is the most important risk factor for ischemic and hemorrhagic stroke, and reduction in blood pressure (BP) after stroke is associated with reduced risk of stroke recurrence1-4. However, for the majority of stroke survivors (SS), hypertension remains poorly controlled early after an incident stroke.5-7 In the United States, Black and Hispanic SS are more likely to have poorly controlled risk factors after stroke compared to White SS, and Black and Hispanic SS have higher rates of stroke recurrence compared to White SS.5-11 Prior efforts to reduce racial disparities in BP control among SS have been uniformly unsuccessful.12 Multicomponent care models that include multidisciplinary approaches show promise for improving risk factor control after stroke.13, 14 Social determinants of health (SDOH) help to explain racial disparities in BP control and stroke recurrence, therefore multidisciplinary post-stroke care models that target SDOH may be key to decreasing disparities in BP control.5, 7, 15 Limited access to post-stroke outpatient care contributes to challenges in developing system-level interventions for post-stroke BP control. Telemedicine and telemonitoring may be ideal approaches for improving access to care in SS. The COVID-19 pandemic has led to rapid expansion of telemedicine for post-acute care in stroke survivors; however, its effectiveness is unproven. Based on preliminary data at our center, we propose a randomized trial testing an integrated multidisciplinary telehealth intervention, the Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL), in SS recently discharged home after inpatient hospitalization for ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The intervention will include post-discharge telehealth visits by a multidisciplinary team, social risk assessments to facilitate social risk-targeted and social risk-informed care, and home BP telemonitoring and management. The care team includes neurology providers (physician and nurse practitioner), a pharmacist, and a social worker. Standard care will include follow-up with a neurologist and primary care provider and pharmacist-assisted BP adjustment. We aim to assess 1) the impact of the intervention on BP control 6 months following stroke assessed with ambulatory BP monitoring; 2) the impact of the intervention on recurrent vascular events 1 year after stroke; 3) the impact of the intervention on health services access and utilization following stroke; 4) moderating effects of race / ethnicity on the impact of the intervention on BP control, vascular events, and health services utilization; 5) the relationship between additional measured SDOH and primary and secondary outcomes.