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

项目总结： 高血压是导致缺血性和出血性中风以及血液减少的最重要危险因素。 中风后的血压(BP)与降低中风复发的风险有关。然而，对于大多数人来说， 中风幸存者(SS)，中风事件发生后早期高血压控制不佳。美国5-7 各州、黑人和西班牙裔党卫军在中风后更有可能出现控制不佳的风险因素 白人SS、黑人和西班牙裔SS的中风复发率高于白人SS。5-11之前 在党卫军中缩小BP控制方面的种族差异的努力一直没有取得一致成功。 包括多学科方法的多组件护理模式显示出改善风险因素的前景 中风后的控制。13、14健康的社会决定因素(SDOH)有助于解释BP控制中的种族差异 和卒中复发，因此针对SDOH的多学科卒中后护理模式可能是 减少血压控制方面的差异。5、7、15中风后门诊治疗的有限机会有助于 为卒中后血压控制开发系统级干预措施的挑战。远程医疗和 远程监测可能是改善SS患者获得护理机会的理想方法。新冠肺炎大流行导致 迅速扩大远程医疗对中风幸存者的急性后护理；然而，其有效性是 未经证实。基于我们中心的初步数据，我们建议进行一项随机试验，测试一个完整的 多学科远程医疗干预，基于视频的干预，以减少治疗和结果 患有中风或短暂性脑缺血发作(虚拟)的成人在最近出院的SS中的差异 因缺血性中风、出血性中风或短暂性脑缺血发作住院后回家。这个 干预措施将包括由多学科团队在出院后进行远程医疗访问，社会风险评估 促进针对社会风险和了解社会风险的护理，以及家庭BP远程监测和管理。这个 护理团队包括神经科提供者(内科医生和护士从业者)、药剂师和社会工作者。 标准护理将包括神经科医生和初级保健提供者的随访以及药剂师协助的BP 调整。我们的目标是评估1)干预对卒中后6个月血压控制的影响 动态血压监测评估；2)干预对再发血管事件1年的影响 3)干预对卒中后卫生服务获取和利用的影响；4) 种族/民族对干预对血压控制、血管事件和 卫生服务利用；5)额外测量的SDOH与一级和二级的关系 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.