학술논문

Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED)
Document Type
article
Source
BMC Neurology. 17(1)
Subject
Clinical Trials and Supportive Activities
Cost Effectiveness Research
Prevention
Nutrition
Behavioral and Social Science
Clinical Research
Neurosciences
Brain Disorders
Stroke
Comparative Effectiveness Research
Heart Disease
Health Services
Hypertension
Heart Disease - Coronary Heart Disease
Cardiovascular
Good Health and Well Being
No Poverty
Adult
Aged
Aged
80 and over
Cerebral Hemorrhage
Community Health Services
Healthcare Disparities
Humans
Ischemic Attack
Transient
Los Angeles
Middle Aged
Outcome Assessment
Health Care
Risk Factors
Safety-net Providers
Secondary Prevention
Single-Blind Method
Community health worker
Transient ischemic attack
Intracerebral hemorrhage
Vascular risk
Blood pressure
Coordinated care
Disparities
NINDS Common Data Elements
Biomarkers
Cognitive Sciences
Neurology & Neurosurgery
Language
Abstract
BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP