Amytis Towfighi|Eric M. Cheng|Monica Ayala-Rivera|Frances Barry|Heather McCreath|David A. Ganz|Martin L. Lee|Nerses Sanossian|Bijal Mehta|Tara Dutta|Ali Razmara|Robert J. Bryg|Shlee Song|Phyllis Willis|Shinyi Wu|Magaly Ramirez|Adam Richards|Nicholas Jackson|Jeremy Wacksman|Brian Mittman|Jamie Tran|Renee Johnson|Chris Ediss|Theresa Sivers-Teixeira|Betty Shaby|Ana L. Montoya|Marilyn Corrales|Elizabeth Mojarro-Huang|Marissa Castro|Patricia Gomez|Cynthia E. Muñoz|Diamond Garcia|Lilian Moreno|Maura Fernandez|Enrique Moratalla López|Sarah Valdez|Hilary Haber|Valerie Hill|Neal Rao|Bibiana Martínez|Lillie Hudson|Natalie Valle|Barbara G. Vickrey
Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack
University of Southern California|Los Angeles County Department of Health Services|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Los Angeles|University of Southern California|Los Angeles County Department of Health Services|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Los Angeles|University of California, Los Angeles|University of California, Los Angeles|VA Greater Los Angeles Healthcare System|University of California, Los Angeles|VA Greater Los Angeles Healthcare System|University of Southern California|LAC+USC Medical Center|University of California, Los Angeles|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Maryland, Baltimore|Rancho Los Amigos National Rehabilitation Center|Kaiser Permanente|University of California, Los Angeles|Olive View-UCLA Medical Center|Cedars-Sinai Medical Center|University of Southern California|University of Washington|Community Partners|University of California, Los Angeles|Dimagi (United States)|VA Greater Los Angeles Healthcare System|Kaiser Permanente|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|California State University Los Angeles|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|Olive View-UCLA Medical Center|Harbor–UCLA Medical Center|Olive View-UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|University of California, Riverside|University of Southern California|LAC+USC Medical Center|Rancho Los Amigos National Rehabilitation Center|Cedars-Sinai Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|Rancho Los Amigos National Rehabilitation Center|Harbor–UCLA Medical Center|Rancho Los Amigos National Rehabilitation Center|University of Southern California|LAC+USC Medical Center|Rancho Los Amigos National Rehabilitation Center|Harbor–UCLA Medical Center|Dimagi (United States)|Brigham and Women's Hospital|University of Cincinnati|University of California, Los Angeles|Olive View-UCLA Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|LAC+USC Medical Center|Harbor–UCLA Medical Center|University of Southern California|Rancho Los Amigos National Rehabilitation Center|St. Jude Medical Center|Icahn School of Medicine at Mount Sinai
h3importanceh3 stroke survivors meet recommended cardiovascular goals particularly among racialethnic minority populations black hispanic individuals socioeconomically disadvantaged populations h3objectiveh3 determine chronic care modelbased community health worker chw advanced practice clinician apc including nurse practitioners physician assistants physician team intervention improves risk factor control stroke safetynet setting ie health care setting individuals receive care regardless health insurance status ability pay h3design setting participantsh3 randomized clinical trial included participants recruited 5 hospitals serving lowincome populations los angeles county california part secondary stroke prevention uniting community chronic care model teams early end disparities succeed clinical trial inclusion criteria age 40 years older experience ischemic hemorrhagic stroke transient ischemic attack tia 90 days prior systolic blood pressure bp 130 mm hg greater 120 130 mm hg history hypertension using hypertensive medications english spanish language proficiency exclusion criterion inability consent among 887 individuals screened eligibility 542 individuals eligible 487 individuals enrolled randomized stratified stroke type ischemic tia vs hemorrhagic language english vs spanish site usual care vs intervention 11 fashion study conducted february 2014 september 2018 data analyzed october 2018 november 2020 h3interventionsh3 participants randomized intervention offered multimodal coordinated care intervention including hypothesized core components ie 3 apc clinic visits 3 chw home visits chronic disease selfmanagement program workshops additional telephone visits protocoldriven risk factor management culturally linguistically tailored education materials selfmanagement tools participants randomized control group received usual care varied site frequently included free bp monitor selfmanagement tools linguistically tailored information materials h3main outcomes measuresh3 primary outcome change systolic bp 12 months secondary outcomes nonhigh density lipoprotein cholesterol hemoglobin asub1csub creactive protein crp levels body mass index antithrombotic adherence physical activity level diet smoking status 12 months potential mediators assessed included access care health stroke literacy selfefficacy perceptions care bp monitor use h3resultsh3 among 487 participants included mean sd age 571 89 years 317 651 men 347 participants 713 hispanic 87 participants 183 black 30 participants 63 asian total 246 participants randomized usual care 241 participants randomized intervention mean sd systolic bp improved 143 17 mm hg baseline 133 20 mm hg 12 months intervention group 146 19 mm hg baseline 137 22 mm hg 12 months usual care group significant differences change groups compared control group participants intervention group greater improvements selfreported salt intake difference 154 95 ci 44 260ipi 004 serum crp level difference log crp 04 95 ci 07 01 mgdlipi 003 differences secondary outcomes although 216 participants 896 intervention group received 3 core components 35 participants 145 received intended full dose h3conclusions relevanceh3 randomized clinical trial complex multilevel multimodal intervention find vascular risk factor improvements beyond usual care however studies may consider testing succeed intervention modifications enhance implementation participant engagement h3trial registrationh3 clinicaltrialsgov identifiernct01763203