Secondary Stroke prevention by Uniting Community and

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 全国最大的县，其安全网医院主要服务于贫困的少数民族人口， 因此，它可以作为测试新的护理干预措施的环境，以消除种族和民族差异。我们是 目前正在测试以系统交付重新设计为重点的护理干预，我们已成功登记 在一项随机对照试验中，有300多名受试者，其中90%的受试者是非白人。我们是 建议通过强调慢性护理中以社区为中心的部分来加强这种干预 社区与慢性病护理模式相结合的二次卒中预防模式干预 团队很容易结束差距(成功)。它由社区卫生工作者(CHW)访问组成 病人在家中，在社区中领导自我管理课程。社区卫生服务中心也将使用移动医疗 促进自身和医生延伸器之间作为护理的沟通的技术 经理们。最后，受试者将获得血压计，以便在家中收集测量数据。一个 指导委员会，由社区领袖、研究人员、非专业人士和学术合作者组成 将确保干预是为文化量身定做的。然后，我们将评估这种增强的慢性护理 基于模型的干预通过对500名说英语的患者进行随机对照试验， 西班牙语、韩语、普通话或广东话，以及最近中风或短暂性脑缺血 进攻。这项研究旨在检测收缩压血的主要结果之间存在8毫米汞的差异。 压力。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，以了解干预影响的稳健性 跨越不同级别的个人和卫生系统特征。我们还将进行成本分析，以 从洛杉矶县卫生服务部的角度成功，并制定一项 洛杉矶县卫生服务部在取得成功后保持成功的可持续性计划 资助期。

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 intervenfions to close racial and ethnic disparifies. 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 intervenfion by emphasizing a community-centered component of a Chronic Care Model-based intervenfion called Secondary stroke prevenfion by Unifing Community and Chronic care model teams Eariy 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 thenhselves 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 intervenfion by conducfing 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.