We propose to assess the comparative effectiveness, relative to usual home care (UHC), of a novel nurse practitioner (NP) + community health worker (CHW) Community Transitions Intervention (CTI) adapted for post-stroke patients and culturally tailored, respectively, to Black and Hispanic patients to account for cultural differences that may influence their disease perceptions and adherence to recommended medical and/or lifestyle regimens. We would conduct a three-arm patient randomized controlled trial (RCT) of post-stroke home health patients assigned to: 1) usual home care (UHC) alone;2) UHC+3-month NP-CTI;or 3) UHC+NP+CHW 3-month CTI. The intervention will focus on: The NP-only and the NP+CHW combined intervention will be assessed relative to usual care and to each other. All patients recruited to the study will have poorly controlled hypertension and, due to disability, will be homebound at study entry. Many also will be characterized by advanced age and other comorbid conditions. The primary outcome will be change in systolic blood pressure (SBP), while secondary outcomes will encompass a range of medical, behavioral, quality of life, and hospitalization outcomes. Measures of these dependent variables will be derived from a combination of primary and secondary data, including patient records, administrative files, patient assessment instruments, patient interviews, home BP measurement and laboratory tests (HbAlc and cholesterol measurement). Data collection will be conducted at baseline, 3 months and 12 months. The principal hypothesis is that the intervention arms will significantly reduce SBP in comparison to UHC. Secondary hypotheses also assume that the intervention arms will yield significant relative advantage compared to LJHC Data analyses will examine both endpoint differences and slopes, using all waves of data. The primary proposed analyses will use mixed random effects models, and a full information maximum likelihood (FIML) approach, with sensitivity analyses using generalized estimating equation (GEE) regression models. Our ultimate goal is to reduce stroke recurrence in this racially and culturally diverse high risk population.

Public Health Relevance

The aim of the study is to evaluate the ability of a Community Transitions Intervention to address significant problems that impede effective post-stroke risk reduction and prevention, including:1) the recurrence of stroke among first time stroke survivors;2) persistent disparities in the burden of stroke and stroke-related morbidity that carry over into stroke recurrence;3) gaps in post-stroke care, particularly in secondary risk reduction;and 4) gaps in transitional care.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Specialized Center--Cooperative Agreements (U54)
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New York University
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Seixas, Azizi A; Henclewood, Dwayne A; Langford, Aisha T et al. (2017) Differential and Combined Effects of Physical Activity Profiles and Prohealth Behaviors on Diabetes Prevalence among Blacks and Whites in the US Population: A Novel Bayesian Belief Network Machine Learning Analysis. J Diabetes Res 2017:5906034
Ortiz, Indira (2016) A Day in the Life of a Home Health Aide/Health Coach. Home Healthc Now 34:340-1
Ravenell, Joseph; Seixas, Azizi; Rosenthal, Diana Margot et al. (2016) Effect of birthplace on cardiometabolic risk among blacks in the Metabolic Syndrome Outcome Study (MetSO). Diabetol Metab Syndr 8:14
Williams, Stephen K; Ravenell, Joseph; Seyedali, Sara et al. (2016) Hypertension Treatment in Blacks: Discussion of the U.S. Clinical Practice Guidelines. Prog Cardiovasc Dis 59:282-288
Ojike, Nwakile; Ravenell, Joe; Seixas, Azizi et al. (2016) Racial Disparity in Stroke Awareness in the US: An Analysis of the 2014 National Health Interview Survey. J Neurol Neurophysiol 7:
Williams, Olajide; Leighton-Herrmann, Ellyn; DeSorbo, Alexandra et al. (2016) Effect of two 12-minute culturally targeted films on intent to call 911 for stroke. Neurology 86:1992-5
James, Caryl; Seixas, Azizi A; Harrison, Abigail et al. (2016) Childhood Physical and Sexual Abuse in Caribbean Young Adults and Its Association with Depression, Post-Traumatic Stress, and Skin Bleaching. J Depress Anxiety 5:
Seixas, A; Ravenell, J; Williams, N J et al. (2016) Uncontrolled blood pressure and risk of sleep apnea among blacks: findings from the Metabolic Syndrome Outcome (MetSO) study. J Hum Hypertens 30:149-52
Schoenthaler, Antoinette; Luerassi, Leanne; Silver, Stephanie et al. (2016) Comparative Effectiveness of a Practice-Based Comprehensive Lifestyle Intervention vs. Single Session Counseling in Hypertensive Blacks. Am J Hypertens 29:280-7
Jean-Louis, Girardin; Grandner, Michael (2016) Importance of recognizing sleep health disparities and implementing innovative interventions to reduce these disparities. Sleep Med 18:1-2

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