Control of stroke risk factors is suboptimal, especially in minority populations. Los Angeles County is the largest county in the country, and its safety net hospitals serve a predominantly indigent, minority population, so it can serve as a setting for testing new care intervenfions to close racial and ethnic disparifies. We are currently testing a care intervention focusing on system delivery redesign, and we have successfully enrolled over 300 subjects in a randomized-controlled trial, of whom 90% of subjects are nonwhite. We are proposing to enhance this intervenfion by emphasizing a community-centered component of a Chronic Care Model-based intervenfion called Secondary stroke prevenfion by Unifing Community and Chronic care model teams Eariy to End Disparities (SUCCEED). It consists of community health workers (CHWs) visiting patients at home and leading self-management classes in the community. CHWs will also use mobile health technology to foster communication between thenhselves and physician extenders serving as care managers. Finally, subjects will be given blood pressure monitors to collect measurements at home. A steering committee, composed of community leaders, researchers, lay persons, and academic collaborators will ensure that the intervention is culturally tailored. We will then evaluate this enhanced chronic care model-based intervenfion by conducfing a randomized-controlled trial of 500 patients who speak English, Spanish, Korean, Mandarin, or Cantonese, and who have suffered a recent stroke or transient ischemic attack. The study is powered to detect an 8 mm Hg difference in the primary outcome of systolic blood pressure. Secondary outcomes consist of controling other stroke risk factors and improving lifestyle habits. We will also collect a set of mediators and moderators to understand robustness of intervention impacts across levels of individual and health system characteristics. We will also conduct a cost analysis of SUCCEED from the perspective of the Los Angeles County Department of Health Services, and develop a sustainability plan for the Los Angeles County Department of Health Services to maintain SUCCEED after the funding period.

Public Health Relevance

To reduce disparities of stroke prevention, we plan to develop and test a care intervention highlighted by 1) community health workers visifing pafients at home and leading self-management classes in the community and 2) implementation of mobile health technology. This care intervention can serve as a prototype for dissemination to other communifies serving a vulnerable populafion.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
1U54NS081764-01
Application #
8476117
Study Section
Special Emphasis Panel (ZNS1-SRB-N (02))
Project Start
2012-09-30
Project End
2017-08-31
Budget Start
2012-09-30
Budget End
2013-08-31
Support Year
1
Fiscal Year
2012
Total Cost
$861,305
Indirect Cost
$189,681
Name
University of California Los Angeles
Department
Type
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Towfighi, Amytis; Cheng, Eric M; Ayala-Rivera, Monica et al. (2017) 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 Dispariti BMC Neurol 17:24
Cheng, Eric M; Myers, Laura J; Vassar, Stefanie et al. (2017) Impact of Hospital Admission for Patients with Transient Ischemic Attack. J Stroke Cerebrovasc Dis 26:1831-1840
Baca, Christine B; Barry, Frances; Vickrey, Barbara G et al. (2017) Social outcomes of young adults with childhood-onset epilepsy: A case-sibling-control study. Epilepsia 58:781-791
Ramirez, Magaly; Wu, Shinyi; Ryan, Gery et al. (2017) Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges. JMIR Res Protoc 6:e94
Bharmal, Nazleen; Lucas-Wright, Anna Aziza; Vassar, Stefanie D et al. (2016) A Community Engagement Symposium to Prevent and Improve Stroke Outcomes in Diverse Communities. Prog Community Health Partnersh 10:149-58
Kwon, Ivy; Bharmal, Nazleen; Choi, Sarah et al. (2016) Older Ethnic Minority Women's Perceptions of Stroke Prevention and Walking. Womens Health Issues 26:80-6
Choi, Sarah E; Kwon, Ivy; Chang, Emiley et al. (2016) Developing a culturally tailored stroke prevention walking programme for Korean immigrant seniors: a focus group study. Int J Older People Nurs 11:255-265
Ramirez, Magaly; Wu, Shinyi; Beale, Elizabeth (2016) Designing a Text Messaging Intervention to Improve Physical Activity Behavior Among Low-Income Latino Patients With Diabetes: A Discrete-Choice Experiment, Los Angeles, 2014-2015. Prev Chronic Dis 13:E171
Song, Sarah; Fonarow, Gregg C; Olson, DaiWai M et al. (2016) Association of Get With The Guidelines-Stroke Program Participation and Clinical Outcomes for Medicare Beneficiaries With Ischemic Stroke. Stroke 47:1294-302
Mensah, George A; Sacco, Ralph L; Vickrey, Barbara G et al. (2015) From Data to Action: Neuroepidemiology Informs Implementation Research for Global Stroke Prevention and Treatment. Neuroepidemiology 45:221-9

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