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次入院，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，卒中幸存者有更高的血管风险因素患病率，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）而再次入院的风险非常高。在门诊治疗中，对血管危险因素的管理不够理想，卒中幸存者对药物治疗不依从。三分之二的中风幸存者有残余残疾，并且经常依赖护理人员运送去诊所就诊。出院后中风护理 在社会上是分散的，不一致的，并已被定性为一个被忽视的战斗。改善药物依从性和减轻护理人员负担的干预措施可以预防再入院，改善结局，并最终降低卒中幸存者医疗护理的社会成本。目前，美国有700万中风幸存者。我们提出了一个概念验证研究，以证明使用在线健康管理工具的自我管理任务和药物治疗管理（MTM）在中风幸存者，使用HTN控制作为一个说明性的例子。将采用2组、平行随机对照试验设计，干预组分配至在线健康管理工具，对照组分配至常规护理。研究目的是：i）评估卒中幸存者及其护理人员在线健康管理工具的可用性; ii）检查入组后3个月干预组与对照组的HTN控制率。iii）检查干预组与对照组在入组后3个月时对抗高血压药物的依从性。将使用AHRQ认可的系统可用性量表评估系统可用性。虽然这项研究说明了我们的概念框架，使用HTN控制的例子，我们设想一个全面的健康信息技术为基础的系统，中风后护理解决多个方面，包括药物管理，康复治疗和生活方式的改变（饮食，运动）在这个高风险人群。这项研究将为更大规模的试验提供初步数据，并将评估在线健康管理工具在中风幸存者（认知，运动和功能限制的患者群体）中的可用性，并确定采用这些工具的障碍。 公共卫生相关性：这项研究建议通过使用在线健康管理工具来改善中风幸存者的药物管理，从而预防复发性血管事件和再入院，以实现“更好的健康和更好的护理，成本更低”。

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.