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.
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.
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