We seek to establish a Center for Stroke Disparities Solutions, as a consortium between three academic institutions (New York University School of Medicine; Columbia University Medical Center; and SUNY Downstate Medical School); five stroke centers and a practice-based research network of primary care practices within New York City's (NYC) Health and Hospital Corporation (HHC) - the largest municipal healthcare system in the U.S.; the Research Division of the Hebrew Home at Riverdale and the Visiting Nurse Service of New York - the largest nonprofit home healthcare organization in the US. The lead institution is New York University School of Medicine (NYUSOM) and the target communities are Black and Hispanic residents of NYC. The Center's vision is to reduce stroke disparities with a particular focus on prevention of recurrent stroke via: 1) implementation of evidence-based interventions targeted at aggressive management of hypertension among stroke survivors in community-based primary care practices and home healthcare settings; 2) dissemination of a novel, culturally-tailored community-based stroke health education; 3) training of minority investigators in stroke disparities research. The Center's vision will be achieved via the establishment of three cores and three research projects. The Administrative Core (Core A) will oversee all administrative, financial and dissemination activities. The Research Education and Training Plan (Core B) will train minority investigators at the junior faculty level to develop successful academic careers in stroke disparities research. The Research Core (Core C) will provide scientific support for the Center. Cores A and C will support all 3 projects: Project I: Practice-based Trial of Home BP Telemonitoring (HBPTM) Among Minority Stroke Survivors is a comparative effectiveness trial of the effects of HBPTM alone versus HBPTM plus telephonic nurse case management, on BP reduction and prevention of recurrent stroke. Project II: Stroke Community Transitions Intervention uses a mixed-methods design to evaluate the effectiveness of a culturally-tailored transition care program delivered by nurse practitioners and community health workers in improving BP control, functional outcomes and quality of life in homebound post-acute stroke patients. Project III: Tailored Approaches to Stroke Health Education uses a mixed-methods design to test the effectiveness of a novel culturally tailored intervention using storytelling (narrative persuasion) in increasing stroke literacy among adults in Black and Hispanic churches across NYC. All 3 projects address barriers that occur along the continuum of stroke care from the community to homecare, and primary care settings.
The vision of the Center for Stroke Disparities Solutions is to reduce stroke disparities with a particular focus on prevention of recurrent stroke. This goal will be realized via: 1) implementation of evidence-based interventions targeted at aggressive management of hypertension among stroke survivors in community based primary care practices and home healthcare settings; 2) dissemination of a novel, culturally-tailored community-based stroke health education; 3) training of minority investigators in stroke disparities research.
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