Secondary Stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities: the SUCCEED Trial

中风危险因素的控制是次优的，特别是在少数民族人群中。洛杉矶县是全国最大的县，它的安全网医院主要服务于贫困的少数民族人口，因此它可以作为一个测试新的护理干预措施的环境，以缩小种族和民族差异。我们目前正在测试一项护理干预，重点是系统交付的重新设计，我们已经成功地在一项随机对照试验中招募了300多名受试者，其中90%的受试者是非白人。我们建议通过联合社区和慢性护理模式团队尽早结束差异（success），强调以社区为中心的基于慢性护理模式的干预，即二级卒中预防，从而加强这种干预。它由社区卫生工作者（chw）上门探访病人和在社区领导自我管理课程组成。卫生保健员还将使用移动医疗技术促进他们自己与作为护理管理人员的医师扩展人员之间的沟通。最后，受试者将获得血压监测器，以便在家中收集测量数据。由社区领袖、研究人员、非专业人员和学术合作者组成的指导委员会将确保干预措施符合文化要求。然后，我们将通过对500名说英语、西班牙语、韩语、普通话或广东话的近期中风或短暂性脑缺血发作的患者进行随机对照试验来评估这种基于慢性护理模式的强化干预。该研究可以检测到收缩压的主要结果有8毫米汞柱的差异。次要结果包括控制其他中风危险因素和改善生活习惯。我们还将收集一组调节因子和调节因子，以了解跨个体和卫生系统特征水平的干预影响的稳健性。我们还将从洛杉矶县卫生服务部门的角度对success进行成本分析，并为洛杉矶县卫生服务部门制定可持续性计划，以在资助期后维持success。

Control of stroke risk factors is suboptimal, especially in minority populations. Los Angeles County is the largest county in the country, and its safety net hospitals serve a predominantly indigent, minority population, so it can serve as a setting for testing new care interventions to close racial and ethnic disparities. We are currently testing a care intervention focusing on system delivery redesign, and we have successfully enrolled over 300 subjects in a randomized-controlled trial, of whom 90% of subjects are nonwhite. We are proposing to enhance this intervention by emphasizing a community-centered component of a Chronic Care Model-based intervention called Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). It consists of community health workers (CHWs) visiting patients at home and leading self-management classes in the community. CHWs will also use mobile health technology to foster communication between themselves and physician extenders serving as care managers. Finally, subjects will be given blood pressure monitors to collect measurements at home. A steering committee, composed of community leaders, researchers, lay persons, and academic collaborators will ensure that the intervention is culturally tailored. We will then evaluate this enhanced chronic care model-based intervention by conducting a randomized-controlled trial of 500 patients who speak English, Spanish, Korean, Mandarin, or Cantonese, and who have suffered a recent stroke or transient ischemic attack. The study is powered to detect an 8 mm Hg difference in the primary outcome of systolic blood pressure. Secondary outcomes consist of controling other stroke risk factors and improving lifestyle habits. We will also collect a set of mediators and moderators to understand robustness of intervention impacts across levels of individual and health system characteristics. We will also conduct a cost analysis of SUCCEED from the perspective of the Los Angeles County Department of Health Services, and develop a sustainability plan for the Los Angeles County Department of Health Services to maintain SUCCEED after the funding period.