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.

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 #
8551800
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
$513,034
Indirect Cost
Name
New York University
Department
Type
DUNS #
121911077
City
New York
State
NY
Country
United States
Zip Code
10016
Ramos, Alberto R; Wallace, Douglas M; Williams, Natasha J et al. (2014) Association between visual impairment and sleep duration: analysis of the 2009 National Health Interview Survey (NHIS). BMC Ophthalmol 14:115
Gutierrez, Jose; Williams, Olajide A (2014) A decade of racial and ethnic stroke disparities in the United States. Neurology 82:1080-2
Jean-Louis, Girardin; Williams, Natasha J; Sarpong, Daniel et al. (2014) Associations between inadequate sleep and obesity in the US adult population: analysis of the national health interview survey (1977-2009). BMC Public Health 14:290
Sealy, LaToya; Oliva, Arthur; National Heart, Lung, and Blood (2014) Hypertension management guidelines update and research on the importance of blood pressure control. Home Healthc Nurse 32:603-9