PREVENTING RECURRENT STROKE IN MINORITY POPULATIONS

随着人口老龄化和中风患病人数的增加，复发性中风正在成为日益重要的医疗保健负担。国家和地方数据强烈表明，这一负担不成比例地福尔斯在少数民族人口身上，特别是黑人和西班牙裔人。该提案旨在确定造成这种差异的因素，并设计和实施一种新的干预措施，以减轻所确定的因素。具体而言，它将重点关注在随机临床试验中证明有效但未在城市少数群体中适当使用的卒中预防措施未得到充分使用的原因。在研究的第一阶段，将审查为研究中的3个种族/族裔群体（黑人、西班牙裔和非西班牙裔白人）提供服务的4家大型城市医院的急性卒中患者图表，以确定这些指标未充分使用的程度。患者和他们的医生将接受采访，以确定这种使用不足的原因。与此同时，一个由当地专家医生组成的小组将最后确定适当注意风险因素战略的拟议标准，其中将包括护士病例管理员利用计算机化提醒系统，并将重点放在初始阶段确认的未充分使用的原因上。在最后阶段，将对试验结果进行分析，并传播结果。

As the population ages and the number of prevalent strokes increases recurrent stroke is combing an increasingly important health care burden. National and local data strongly suggest that this burden falls disproportionately on minority populations, notably Blacks and Hispanics. This proposal seeks to determine the factors that contribute to that disparity and design and implement a novel intervention tailored to alleviate the factors identified. Specifically it will focus on causes of underuse of stroke preventive measures demonstrated in randomized clinical trials to be efficacious, but not appropriately utilized in urban, minority populations. In the first phase of the study charts of acute stroke patients in 4 large urban hospitals that serve the 3 racial/ethnic groups under study (Blacks, Hispanics and non-Hispanic whites) will be reviewed to determine the magnitude of underuse of these measures. Patients and their physicians will be interviewed to identify the perceived reasons for this underuse. Simultaneously, a panel of local expert physicians will finalize the proposed criteria for appropriate attention to risk factor strategy that will include nurse case managers utilizing a computerized reminder system and focusing on the causes of underuse confirmed in the initial phase will be undertaken. In the final phase the results of the trial will be analyzed and the results disseminated.