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，其安全网医院服务的主要是贫困的少数民族人口，因此它可以作为测试新的护理干预措施以缩小种族和民族差异的环境。 我们目前正在测试一种专注于系统交付重新设计的护理干预措施，我们已经成功地在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。 我们建议通过强调以社区为中心的慢性病护理模式为基础的干预措施的组成部分，通过联合社区和慢性病护理模式团队的早期到最终差异（成功）来加强这种干预措施。 它由社区卫生工作者组成，他们到病人家中探访病人，并在社区领导自我管理课程。 CHW还将使用移动的健康技术来促进他们与作为护理管理者的医生扩展者之间的沟通。 最后，将为受试者提供血压监测仪，以便在家中收集测量结果。 由社区领导人、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特点。 然后，我们将通过对500名讲英语、西班牙语、韩语、普通话或广东话的患者进行随机对照试验，评估这种基于增强型慢性护理模式的干预措施，这些患者最近患有中风或短暂性脑缺血发作。 该研究有把握检测收缩压主要结局的8 mm Hg差异。 次要结局包括控制其他卒中危险因素和改善生活习惯。我们还将收集一组调解人和主持人，以了解干预措施对个人和卫生系统特征的影响。 我们亦会从洛杉矶郡卫生服务部的角度，进行SUCCEED的成本分析，并为洛杉矶郡卫生服务部制订可持续发展计划，以便在资助期结束后维持SUCCEED。

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.