The long-term research goal is to develop care management interventions to prevent hospital readmissions in stroke survivors and thereby improve stroke survival, reduce cumulative disability due to recurrent vascular events and prevent post-stroke complications. Stroke survivors have a greater prevalence of vascular risk factors, namely, hypertension (HTN), diabetes mellitus and elevated cholesterol, compared to the general population. Consequently, they are at a very high risk of post-stroke hospital readmissions for vascular events such as recurrent stroke, heart attacks and heart failure. There is sub-optimal management of vascular risk factors in the outpatient setting and medication non-compliance by stroke survivors. Two-thirds of stroke survivors have residual disabilities and are frequently dependent on caregivers for transportation to clinic visits. Post- discharge stroke care in the community is fragmented, inconsistent and has been characterized as a neglected battle. Interventions to improve medication compliance and reduce caregiver burden can prevent hospital readmissions, improve outcomes and ultimately decrease societal costs of medical care for stroke survivors. Currently, there are 7 million stroke survivors in the United States. We propose a proof-of-concept study to demonstrate the use of an online health management tool for self management tasks and Medication Therapy Management (MTM) in stroke survivors, using HTN control as an illustrative example. A 2-group, parallel randomized control trial design will be used with the intervention group assigned to the online health management tool and the control group assigned to usual care.
Study aims will i) Assess usability of the online health management tool by stroke survivors and their caregivers;ii) Examine rates of HTN control in the intervention vs. control groups at 3 months after enrollment. iii) Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. System usability will be assessed with the AHRQ recognized System Usability Scale. While this study illustrates our conceptual framework using the example of HTN control, we envision a comprehensive health IT based system for post-stroke care addressing multiple aspects including medication management, rehabilitative therapy and lifestyle modification (diet, exercise) in this high risk population. This study will provide preliminary data for a larger trialand will evaluate the usability of online health management tools among stroke survivors, (a patient group with cognitive, motor and functional limitations) and, identify barriers to their adoption.
This study proposes to achieve better health and better care at lower cost by using an online health management tool to improve medication management in stroke survivors, thereby preventing recurrent vascular events and hospital readmissions.