Promoting Self-Management in Stroke Survivors Using Health IT

描述（由申请人提供）：长期研究目标是开发护理管理干预措施，以防止卒中幸存者再入院，从而提高卒中生存率，减少因复发性血管事件导致的累积残疾，并预防卒中后并发症。与一般人群相比，中风幸存者有更大的血管危险因素，即高血压（HTN）、糖尿病和胆固醇升高。因此，他们中风后因血管事件（如复发性中风、心脏病发作和心力衰竭）再入院的风险非常高。在门诊设置和中风幸存者的药物依从性血管危险因素的次优管理。三分之二的中风幸存者仍有残障，经常依靠护理人员接送他们去诊所就诊。中风出院后护理

DESCRIPTION (provided by applicant): The long-term research goal is to develop care management interventions to prevent hospital readmissions in stroke survivors and thereby improve stroke survival, reduce cumulative disability due to recurrent vascular events and prevent post-stroke complications. Stroke survivors have a greater prevalence of vascular risk factors, namely, hypertension (HTN), diabetes mellitus and elevated cholesterol, compared to the general population. Consequently, they are at a very high risk of post-stroke hospital readmissions for vascular events such as recurrent stroke, heart attacks and heart failure. There is sub-optimal management of vascular risk factors in the outpatient setting and medication non-compliance by stroke survivors. Two-thirds of stroke survivors have residual disabilities and are frequently dependent on caregivers for transportation to clinic visits. Post- discharge stroke care in the community is fragmented, inconsistent and has been characterized as a neglected battle. Interventions to improve medication compliance and reduce caregiver burden can prevent hospital readmissions, improve outcomes and ultimately decrease societal costs of medical care for stroke survivors. Currently, there are 7 million stroke survivors in the United States. We propose a proof-of-concept study to demonstrate the use of an online health management tool for self management tasks and Medication Therapy Management (MTM) in stroke survivors, using HTN control as an illustrative example. A 2-group, parallel randomized control trial design will be used with the intervention group assigned to the online health management tool and the control group assigned to usual care. Study aims will i) Assess usability of the online health management tool by stroke survivors and their caregivers; ii) Examine rates of HTN control in the intervention vs. control groups at 3 months after enrollment. iii) Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. System usability will be assessed with the AHRQ recognized System Usability Scale. While this study illustrates our conceptual framework using the example of HTN control, we envision a comprehensive health IT based system for post-stroke care addressing multiple aspects including medication management, rehabilitative therapy and lifestyle modification (diet, exercise) in this high risk population. This study will provide preliminary data for a larger trialand will evaluate the usability of online health management tools among stroke survivors, (a patient group with cognitive, motor and functional limitations) and, identify barriers to their adoption. PUBLIC HEALTH RELEVANCE: This study proposes to achieve "better health and better care at lower cost" by using an online health management tool to improve medication management in stroke survivors, thereby preventing recurrent vascular events and hospital readmissions.