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

基于视频的干预措施可减少中风或短暂性脑缺血发作成人的治疗和结果差异（虚拟）

• 批准号: 10490912
• 负责人: Anjail Z Sharrief
• 金额: $ 65.72万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-18 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10490912
• 关键词: Accident and Emergency department; Acute; Address; Adult; Ambulatory Blood Pressure Monitoring; Ambulatory Care; Area; Behavior; Black race; Blood Pressure; Blood Pressure Monitors; Blood Vessels; Brain hemorrhage; COVID-19 pandemic; Caring; Cessation of life; Cities; Clinical; Communities; Coronary; Data; Discrimination; Effectiveness; Enrollment; Environment; Ethnic Origin; Event; Health Services Accessibility; Healthcare; Heart failure; Heterogeneity; Hispanic; Home; Hospitalization; Hospitals; Hour; Hypertension; Improve Access; Inpatients; Insurance; Insurance Coverage; Intervention; Ischemic Stroke; Language; Link; Measures; Medicaid; Medical; Modeling; Myocardial Infarction; Neighborhoods; Neurologist; Neurology; Nurse Practitioners; Outcome; Outpatients; Patients; Pharmacists; Physicians; Provider; Race; Randomized; Recurrence; Research; Resources; Risk; Risk Assessment; Risk Factors; Services; Social Workers; Social support; Socioeconomic Status; Stroke; System; Technology; Telemedicine; Testing; Transient Ischemic Attack; Treatment outcome; Uninsured; United States; Visit; acute care; base; blood pressure control; blood pressure reduction; care delivery; care providers; care systems; cohort; comparative effectiveness trial; ethnic diversity; evidence based guidelines; experience; follow-up; food insecurity; health care service utilization; health service use; hospital readmission; improved; indexing; individual patient; interdisciplinary approach; intervention effect; metropolitan; mortality; multi-component intervention; multidisciplinary; post intervention; post stroke; predictive modeling; primary outcome; programs; racial and ethnic disparities; racial disparity; racial diversity; racism; randomized trial; recruit; secondary outcome; segregation; social; social health determinants; social vulnerability; standard care; stroke risk; stroke survivor; telehealth; telemonitoring; trial comparing; urgent care; video visit; virtual intervention; virtual model

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.

项目摘要： 高血压是缺血性和出血性中风的最重要危险因素，血液的减少 中风后的压力（BP）与中风复发的风险降低有关1-4。但是，对于大多数 中风幸存者（SS），高血压在事件中风后尽早控制不良。5-7联合 州，黑人和西班牙裔SS中风后的危险因素更可能与 白色SS，黑色和西班牙裔SS的中风复发率更高，而白色则为5-11。 减少SS中BP控制种族差异的努力均无成功。12 包括多学科方法在内的多组分护理模型显示了改善风险因素的希望 中风后的控制。13，14个健康的社会决定因素（SDOH）有助于解释BP控制中的种族差异 和中风复发，因此，针对SDOH的多学科后抛光后护理模型可能是 BP控制中的差异减少。5、7、15有限的中风后门诊护理的访问有助于 制定系统级干预措施的挑战，以进行势后BP控制。远程医疗和 远程监控可能是改善SS获得护理访问的理想方法。 COVID-19大流行已导致 远程医疗在中风幸存者中快速扩张；但是，其有效性是 未经证实。根据我们中心的初步数据，我们提出了一个随机试验测试 多学科远程医疗干预，基于视频的干预措施，以减少治疗和结果 SS最近出院的成年人患有中风或短暂性缺血性攻击（虚拟）的差异 住院治疗后的住院治疗，出血性中风或短暂性缺血性发作后住所。这 干预措施将包括跨学科团队的远程医疗远程医疗访问，社会风险评估 促进针对社会风险和社会风险的护理以及家庭BP远程监控和管理。这 护理团队包括药剂师和社会工作者的神经病学提供者（医师和护士从业人员）。 标准护理将包括对神经科医生和初级保健提供者以及药剂师协助的BP的随访 调整。我们的目标是评估1）中风后6个月对BP控制的影响 通过卧床BP监测评估； 2）干预对复发性血管事件的影响1年 中风后； 3）干预对中风后卫生服务访问和利用的影响； 4） 种族 /民族对干预对BP控制，血管事件和 卫生服务利用； 5）额外测量的SDOH与初级和次要之间的关系 结果。