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.
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.
|Cheng, Eric M; Cunningham, William E; Towfighi, Amytis et al. (2018) Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors: A Randomized Controlled Trial. Circ Cardiovasc Qual Outcomes 11:e003228|
|Bharmal, Nazleen H; McCarthy, William J; Gadgil, Meghana D et al. (2018) The Association of Religious Affiliation with Overweight/Obesity Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study. J Relig Health 57:33-46|
|Ramirez, Magaly; Wu, Shinyi (2017) Phone Messaging to Prompt Physical Activity and Social Support Among Low-Income Latino Patients With Type 2 Diabetes: A Randomized Pilot Study. JMIR Diabetes 2:e8|
|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|
|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|
|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|
|Robinson, Maisha T; Vickrey, Barbara G; Holloway, Robert G et al. (2016) The lack of documentation of preferences in a cohort of adults who died after ischemic stroke. Neurology 86:2056-62|
|Lin, Michelle P; Ovbiagele, Bruce; Markovic, Daniela et al. (2016) Association of Secondhand Smoke With Stroke Outcomes. Stroke 47:2828-2835|
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