Hypertension Improvement Pilot Intervention in Post-Stroke Veterans

背景：退伍军人医院每年有超过6,000名退伍军人因急性缺血性中风入院。 医疗保健系统。近25%的中风是反复发作的事件，是导致残疾的主要原因 在我们的退伍军人群体中，尤其是75%患有中风和高血压的退伍军人中，死亡人数越来越多。 目前的VA/DoD和美国心脏协会/美国中风协会(AHA/ASA)指南强调 鉴于这种强烈的关联性，提供高血压指南协调管理的重要性 目标血压与降低发病率和死亡率之间的关系，特别是在后六个月 卒中期间，大多数中风和非中风相关的住院和死亡发生在这一时期。以前的质量 增强研究倡议(QUERI)的工作表明，许多退伍军人在中风后6个月 他们的血压没有得到最佳的控制。大多数退伍军人患有中风后风险高血压 退伍军人初级保健和患者导向护理团队(PACT)内的护理。在当前工作期间执行的工作 卫生服务研究与开发(HSR&D)职业发展奖(CDA)期限已确定 可以帮助初级保健/PACT中的门诊提供者更好地管理的几个干预领域 高血压使用现有的退伍军人管理局基础设施，并导致了捆绑、循证、 “卒中后高血压改善干预”因此，重点预防未来的中风，通过 实施有效治疗退伍军人中风高血压的干预措施是必要的 改善这一人群的结果。 目的：(1)评价试点干预的可行性和可接受性 VAMC为中风后退伍军人提供次优的血压管理，在高危时期，6- 中风后一个月的时间，这样可以制定更精细的干预措施，并由Key进一步通知 利益相关者、最终用户和战略合作伙伴；以及(2)收集与高血压控制相关的指标 干预点和4个控制点。 方法：将在Michael E.DeBakey VAMC启动试点。综合框架，用于 将使用实施研究(CFIR)概念框架和系统重新设计战略 评估干预措施的实施情况。实施战略的可行性和可接受性 将通过与干预最终用户的定性访谈进行评估。将测量血压 基线、3个月和6个月。基线人口和人口的分布和中心趋势 连续变量的患者、提供者和设施级别的特征将以图形和 汇总统计信息。分类变量将通过计算频率分布来检验。我们会 根据患者数量和平均设施水平血压，匹配我们的干预和控制地点。 假设：我们相信我们可以：(1)确定试点干预的可行性和可接受性 旨在改善出院后6个月的中风后高血压控制；以及(2)收集相关指标 对参与干预的退伍军人高血压控制情况及4个控制点进行效果评估 为未来的更大规模的试验做准备。 结论：改善退伍军人缺血性卒中高血压管理的干预措施是 对于预防复发中风是必要的；实施科学策略可以评估摄取和 这种干预的可持续性。

Background: Over 6,000 Veterans are admitted with an acute ischemic stroke annually within the VA Healthcare System. Nearly 25% of all strokes are recurrent events and constitute a leading cause of disability and death within our Veteran population, especially among the 75% of Veterans with stroke and hypertension. Current VA/DoD and American Heart Association/American Stroke Association (AHA/ASA) guidelines stress the importance of delivering guideline concordant management of hypertension, given the strong association between goal blood pressure and decreased morbidity and mortality, especially during the six-month post- stroke period, when most stroke and non-stroke related hospitalizations and deaths occur. Previous Quality Enhancement Research Initiative (QUERI) work has shown that many Veterans 6-months after their stroke do not have their blood pressure optimally controlled. Most Veterans receive their post-stroke risk hypertension care within VA Primary Care and Patient Aligned Care Teams (PACTs). Work performed during the current Health Services Research and Development (HSR&D) Career Development Award (CDA) period has identified several areas for intervention that can assist outpatient providers in Primary Care/PACT to better manage hypertension using existing VA infrastructure, and has led to the development of a bundled, evidence-based, `Post Stroke Hypertension Improvement Intervention.' Therefore, focusing on prevention of future strokes by implementing an intervention to effectively treat hypertension among Veterans with stroke is necessary to improve outcomes in this population. Objective: To: (1) evaluate the feasibility and acceptability of a pilot intervention, implemented at a single VAMC providing suboptimal blood pressure management to post-stroke Veterans, during the `high-risk,' 6- month period post-stroke, such that a more refined intervention can be developed and further informed by key stakeholders, end users, and strategic partners; and (2) collect metrics related to hypertension control at the intervention and four control sites. Methods: A pilot will be initiated at the Michael E. DeBakey VAMC. The Consolidated Framework for Implementation Research (CFIR) conceptual framework and Systems Redesign strategies will be used to evaluate the implementation of the intervention. The feasibility and acceptability of the implementation strategy will be assessed via qualitative interviews with end users of the intervention. Blood pressure will be measured at baseline, 3-months, and 6-months. The distributions and central tendencies of baseline demographic and patient-, provider-, and facility-level characteristics for continuous variables will be examined graphically and by summary statistics. Categorical variables will be examined by calculating frequency distributions. We will match, based on patient volume and mean facility-level blood pressure, our intervention and control sites. Hypothesis: We believe that we can: (1) determine the feasibility and acceptability of a pilot intervention designed to improve post-stroke hypertension control 6-months after discharge; and (2) collect metrics related to hypertension control among Veterans participating in the intervention and four control sites to estimate effect size for a future, larger trial. Conclusion: Interventions that improve management of hypertension among Veterans with ischemic stroke are necessary to prevent recurrent strokes; implementation science strategies can assess the uptake and sustainability of this intervention.