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

对中风危险因素的控制是次优的，特别是在少数民族人群中。洛杉矶县是美国最大的县，其安全网医院主要为贫困的少数族裔人口服务，因此可以作为测试新的医疗干预措施的环境，以缩小种族和民族差异。我们目前正在测试以系统交付重新设计为重点的护理干预，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及早结束差异(成功)来加强这一干预措施，强调基于慢性病护理模式的干预措施中以社区为中心的部分，称为二级中风预防。它由社区卫生工作者(CHW)在家中探望病人和在社区领导自我管理课程组成。社区卫生工作者还将使用移动卫生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，受试者将获得血压计，以便在家中收集测量数据。一个由社区领导人、研究人员、非专业人士和学术合作者组成的指导委员会将确保干预是根据文化定制的。然后，我们将通过对500名说英语、西班牙语、韩语、普通话或粤语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，这些患者最近遭受过中风或短暂性脑缺血发作。这项研究的目的是检测收缩压的主要结果之间存在8毫米汞的差异。次要结果包括控制其他中风风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，以了解不同水平的个人和卫生系统特征的干预影响的稳健性。我们还将从洛杉矶县卫生服务部的角度对Success进行成本分析，并为洛杉矶县卫生服务部制定可持续发展计划，以在资助期后保持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.