As the population ages and the number of prevalent strokes increases recurrent stroke is combing an increasingly important health care burden. National and local data strongly suggest that this burden falls disproportionately on minority populations, notably Blacks and Hispanics. This proposal seeks to determine the factors that contribute to that disparity and design and implement a novel intervention tailored to alleviate the factors identified. Specifically it will focus on causes of underuse of stroke preventive measures demonstrated in randomized clinical trials to be efficacious, but not appropriately utilized in urban, minority populations. In the first phase of the study charts of acute stroke patients in 4 large urban hospitals that serve the 3 racial/ethnic groups under study (Blacks, Hispanics and non-Hispanic whites) will be reviewed to determine the magnitude of underuse of these measures. Patients and their physicians will be interviewed to identify the perceived reasons for this underuse. Simultaneously, a panel of local expert physicians will finalize the proposed criteria for appropriate attention to risk factor strategy that will include nurse case managers utilizing a computerized reminder system and focusing on the causes of underuse confirmed in the initial phase will be undertaken. In the final phase the results of the trial will be analyzed and the results disseminated.
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