Disparities in cardiovascular disease, including stroke, remain a major public health problem in the United States. There is an urgent need for secondary prevention strategies that can help to reduce these disparities and the overall burden of stroke. However, progress toward this goal has been hindered by the lack of comparative effectiveness and cost-effectiveness data, particulariy in minority populations, and insufficient utilization of health information technology that is needed to support the dissemination and long-term sustainability of empirically supported interventions. The proposed study will address these critical gaps in the literature by evaluating the comparative effectiveness and cost-effectiveness of a 12-month home blood pressure telemonitoring (HBPTM) intervention versus HBMTM supplemented with individualized, culturally tailored telephone-based nurse case management (NCM) among Black and Hispanic stroke survivors with uncontrolled hypertension. A sample of 450 participants will be recruited from stroke centers and primary care practices at four hospitals in the New York City Health and Hospitals Corporation (HHC) Network, which serves more than 1.3 million urban, diverse patients. Participants will complete study assessments at baseline, 6-months, 12-months and 24-months. The primary outcomes are 12-month change in blood pressure and 24-month stroke recurrence;secondary outcomes are cost-effectiveness at these two time points. The primary hypothesis is that the combined HBPTM+NCM intervention will have greater effects on BP reduction and stroke recurrence and, while it will be more costly, it will also be more cost-effective than HBPTM alone. Possible mechanisms ofthe intervention effects will also be examined, including antihypertensive treatment intensification, health behaviors (diet, physical activity, medication adherence), and other stroke risk factors (diabetes, hyperiipidemia). Major strengths ofthe study include the use of existing health information technology, the evaluation of cost-effectiveness, and a plan to evaluate the sustainability of effects beyond the formal 12-month intervention period. Findings from the proposed study will have important clinical, research and policy implications.

Public Health Relevance

This study will assess the comparative effectiveness, cost-effectiveness, and sustainability of two telemonitoring interventions in reducing blood pressure and recurrent stroke among high-risk Black and Hispanic stroke patients. Results of this study will provide strong empirical evidence to inform clinical guidelines and practice, which may lead to reductions in stroke disparities in the United States.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54NS081765-02
Application #
8551799
Study Section
Special Emphasis Panel (ZNS1-SRB-N)
Project Start
Project End
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
2
Fiscal Year
2013
Total Cost
$580,897
Indirect Cost
$210,836
Name
New York University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
121911077
City
New York
State
NY
Country
United States
Zip Code
10016
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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