Program to Avoid Cerebrovascular Events Through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor (PACESETTER)

通过系统电子跟踪和调整显着风险因素来避免脑血管事件的计划 (PACESETTER)

• 批准号: 9690460
• 负责人: BRUCE OVBIAGELE
• 金额: $ 40.96万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9690460
• 关键词: Accident and Emergency department; Achievement; Address; Adherence; African American; Area; Blood Pressure; Blood Vessels; Car Phone; Cardiovascular system; Cause of Death; Cellular Phone; Cessation of life; Cities; Clinic Visits; Country; Data; Death Rate; Dementia; Ethnography; Event; Failure; Future; Goals; Guidelines; Health; Health Communication; Health Technology; Home Blood Pressure Monitoring; Home environment; Hospitals; Hypertension; Intervention; Ischemic Stroke; Link; Medical; Modeling; Monitor; Myocardial Infarction; Not Hispanic or Latino; Patient Care; Patients; Pharmaceutical Preparations; Prevalence; Prevention strategy; Provider; Public Health; Race; Randomized Controlled Trials; Reporting; Research; Rest; Risk; Risk Factors; Rural; Self Blood Pressure Monitoring; Self Management; Signal Transduction; South Carolina; Stroke; Stroke Belt; Stroke prevention; Surveys; Symptoms; System; Telephone; Testing; Text Messaging; Theoretical model; Therapeutic; Time; United States; Universities; base; blood pressure regulation; care outcomes; care providers; cerebrovascular; clinical efficacy; disability; ethnic minority population; evidence base; experience; forgetting; high risk; hospital readmission; hypertension control; implementation trial; improved; indexing; mHealth; medically underserved population; medication compliance; medication nonadherence; modifiable risk; mortality; pill; population based; post stroke; practice setting; primary outcome; programs; recruit; safety net; standard care; stroke incidence; stroke patient; stroke survivor; stroke symptom; systematic review; telehealth; treatment as usual; urban disparity; virtual; willingness

Racial and rural-urban disparities in stroke care and outcomes are most prominent in the Southeastern region of the US, where 3 states have long been recognized as representing the `buckle' of a `stroke belt', i.e. highly stroke-prone tri-state area within a broader region already more heavily burdened with stroke compared to the rest of the country. One of these 3 states is South Carolina (SC). Fortunately, stroke is eminently preventable and hypertension (HTN) is the premier modifiable risk factor for stroke, but fewer than one third of patients with a recent stroke have their blood pressure (BP) controlled ≥75% of the time and low consistency of BP control is linked to higher risk of future major vascular events. Key factors responsible for uncontrolled HTN in African Americans (AA) are medication non-adherence and failure to intensify therapy in a timely manner. As such, culturally-tailored, efficacious blood pressure control programs which are acceptable, feasible, timely, and sustainable are needed, especially among hypertensive stroke survivors who reside in the stroke buckle or who are AA. Mobile health (mHealth) technology offers a promising approach to address this need. The overall objective of the Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor (PACESETTER) study is to demonstrate that a theoretical-model- based, mHealth technology-centered, multi-level integrated approach can be effectively implemented to improve sustained BP control among stroke patients encountered in South Carolina (at least half of whom will be AA) within one month of stroke symptom onset. The primary aim is conduct an implementation trial (at the patient level) of the PACESETTER intervention [health technology (personalized phone text messaging and home BP monitoring)] vs. usual care in 200 recent stroke patients with hypertension recruited across the three main safety net hospitals in the state of SC (in the cities of Charleston, Columbia, and Greenville). Primary outcome will be achievement of guideline-recommended systolic blood pressure control at 12 months. We also aim to explore whether implementation of the PACESETTER intervention vs. standard care is associated with a reduction in subsequent cardiovascular event-related re-hospitalizations, shows a signal of potential efficacy in reducing actual vascular events, and has distinct effects on providers caring for patients with stroke. Altogether, the PACESETTER intervention, if proven effective and implementable, may eventually be exported to other medically underserved populations in the US beyond SC, as a feasible model of evidence-based post-stroke management.

中风护理和成果的种族和崎and堡差异在 美国东南部地区，长期以来，三个州被认为代表了一个 “中风腰带”，即在更广阔的区域内易于燃烧的更广阔地区的三态三州区域 中风与全国其他地区相比。这三个州之一是南卡罗来纳州（SC）。幸运的是，中风 是可以预防的，高血压（HTN）是中风的主要风险因素，但更少 最近中风的患者中有三分之一的血压（BP）的时间≥75％，并且 BP控制的低一致性与未来重大血管事件的较高风险有关。负责的关键因素 对于非洲裔美国人（AA）中不受控制的HTN是药物不遵守和未能加强 及时治疗。因此，经过文化的，有效的血压控制计划 需要接受，可行，及时和可持续性，尤其是在高血压幸存者中 谁居住在中风扣或AA。移动健康（MHealth）技术提供了希望 解决这一需求的方法。该计划的总体目标避免脑血管事件 通过系统的电子跟踪和量身定制的显着风险因素（PaceSetter）研究是 证明一种基于理论模型的，以MHealth技术为中心的多级集成方法 可以有效地实施以改善南方遇到的中风患者的持续BP控制 在中风症状发作的一个月内，卡罗来纳州（至少一半将是AA）。主要目的是 对pacesetter干预[卫生技术 （个性化电话短信和家庭BP监控）]在最近的200名中风患者中 在SC州的三家主要安全网医院中招募高血压（在 查尔斯顿，哥伦比亚和格林维尔）。主要结果将是指定指南的结果 收缩压控制12个月。我们还旨在探讨是否实施 Pacesetter干预与标准护理与随后的心血管的减少有关 与事件相关的重新建筑化，显示了降低实际血管​​事件的潜在效率的信号，以及 对携带中风患者的提供者具有明显的影响。总共，固定干预，如果 被证明有效且可实施的，最终可能出口到其他医学欠缺的人群 在美国超越SC的美国，作为基于证据的势后管理的可行模型。