A Randomized Pilot Trial of a Digital Health Platform To Control BP To Address Stroke Disparities

中风是残疾、认知障碍和死亡的主要原因。2019冠状病毒病疫情已经浮出水面 在包括中风在内的一系列疾病中存在长期和严重的健康差距。与其他群体相比， 非裔美国人有更高的中风危险因素的患病率，包括高血压，糖尿病， 糖尿病、高胆固醇和外周血管疾病。这些因素因以下方面的差异而复杂化： 社会经济地位，导致中风患病率和死亡率较高。然而，越来越多的证据表明， 表明大多数中风可以通过控制可改变的危险因素来预防。在这方面的指导假设 研究表明，针对有色人种血压控制的干预措施可以缩小种族和民族之间的差距。 中风复发率的差异。虽然研究有限，但已经表明，远程保健可以 有效地用于降低有色人种的血压。拟议的研究利用了 一个卒中差异调查小组在一名非裔美国人中进行了一项试点随机对照试验（RCT） 以及布鲁克林中部的加勒比黑人拟议的研究是由一个翻译通知 实施科学框架和我们开发的称为中风数字公平的干预模型 （德萨）。德萨的创新在于整合四个新的组成部分：提供宽带互联网 (or解决数字鸿沟，加强家庭照顾者支助，灵活（远程保健、短信、电子邮件） 患者和临床医生之间的远程双向通信，以及实时远程BP监测。该提案 由三个目标组成，分别对应于以下阶段：试验前准备RCT和试验后 检查促进者和障碍的阶段。我们将采用收敛混合方法设计来指导数据 收集和分析。第一个目标是通过制定数字股权计划为RCT奠定基础， 评估用户体验，并进行初步的远程保健实验，以确保可用性、流程和 解决执行问题。在试点随机对照试验中，我们将测试德萨小组是否会导致净减少 与常规护理相比，参与者组的血压控制和药物依从性改善。我们 将卒中患者随机分配至一项为期9个月的试点RCT（标准治疗，N=40 vs.德萨，N=40）。我们的首要 假设随机分配至德萨组的患者在9个月时收缩压（SBP）降低幅度更大 比对照组的病人。所有患者都将收到一个BP监测器，它将捕获、存储和自动传输BP 通过加密的蜂窝连接将读数实时发送到安全服务器。随机分配到德萨的参与者 还将收到一个安装了必要应用程序的触摸屏远程医疗平板电脑，以及一个移动电话。 连接已启用。第三个目标/试验后阶段将通过调查和主要知情人访谈征求反馈意见。 最终目标是为多学科研究计划和一个强大的，高科技， 社区参与的数字医疗解决方案，将同步数据收集和数据共享， 社区组织、医疗保健系统和学术机构的网络。

Stroke is a leading cause of disability, cognitive impairment, and death. The COVID-19 pandemic has surfaced longstanding and severe health disparities in a range of conditions, including stroke. Compared to other groups, African American individuals have a higher prevalence of stroke risk factors, including hypertension, diabetes mellitus, high cholesterol, and peripheral vascular disease. These factors are compounded by differences in socioeconomic status, leading to higher stroke prevalence and mortality. However, there is growing evidence to suggest that most strokes can be prevented by controlling modifiable risk factors. The guiding assumption in this research is that interventions targeting blood pressure (BP) control in people of color can narrow racial and ethnic disparities in stroke recurrence. Although there is limited research, it has been shown that telehealth can be effectively used to reduce BP in populations of color. The proposed research leverages preliminary work by the investigative team on stroke disparities to conduct a pilot randomized control trial (RCT) in an African American and Afro-Caribbean population in Central Brooklyn. The proposed studies are informed by a TRANSCREATION implementation science framework and an intervention model we developed called the Digital Equity for Stroke Approach (DESA). DESA’s innovation lies in integrating four novel components: provision of broadband internet (or equivalent) to address the digital divide, enhanced family caregiver support, flexible (telehealth, text, email) remote two-way communication between patient and clinician, and real-time remote BP monitoring. The proposal is constituted by three aims, corresponding to the following stages: pre-trial preparatory RCT and post-trial phases that examine facilitators and barriers. We will employ a convergent mixed method design to guide data collection and analysis. The first aim lays the foundation for the RCT by developing a digital equity plan, assessing user experience, and conducting preliminary telehealth experiments to ensure usability, flow and address implementation issues. In the pilot RCT, we will test whether the DESA group will lead to a net reduction in BP control and improvement in medication adherence in the participant group compared to usual care. We will randomize stroke patients into a 9-month pilot RCT (standard care, N=40 vs. DESA, N=40). Our primary hypothesis is that patients randomized to DESA will have a greater reduction in systolic BP (SBP) at 9 months than control patients. All patients will receive a BP Monitor that will capture, store and automatically transmit BP readings in real-time to a secure server via an encrypted cellular connection. Participants randomized to DESA will also receive a touch screen telehealth tablet with the necessary applications installed, and a cellular connection enabled. The third aim/ post-trial phase will solicit feedback via a survey and key informant interviews. The ultimate objective is to build capacity for a multidisciplinary research program and a robust, high-tech, community-engaged digital health solution that will synchronize data collection and data sharing across a network of community-based organizations, healthcare systems, and academic institutions.