Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL)

Information

  • Research Project
  • 10290172
  • ApplicationId
    10290172
  • Core Project Number
    R01MD016465
  • Full Project Number
    1R01MD016465-01
  • Serial Number
    016465
  • FOA Number
    PA-20-183
  • Sub Project Id
  • Project Start Date
    9/18/2021 - 3 years ago
  • Project End Date
    5/31/2026 - a year from now
  • Program Officer Name
    DAGHER, RADA K
  • Budget Start Date
    9/18/2021 - 3 years ago
  • Budget End Date
    5/31/2022 - 2 years ago
  • Fiscal Year
    2021
  • Support Year
    01
  • Suffix
  • Award Notice Date
    9/18/2021 - 3 years ago

Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL)

Project Summary: Hypertension is the most important risk factor for ischemic and hemorrhagic stroke, and reduction in blood pressure (BP) after stroke is associated with reduced risk of stroke recurrence1-4. However, for the majority of stroke survivors (SS), hypertension remains poorly controlled early after an incident stroke.5-7 In the United States, Black and Hispanic SS are more likely to have poorly controlled risk factors after stroke compared to White SS, and Black and Hispanic SS have higher rates of stroke recurrence compared to White SS.5-11 Prior efforts to reduce racial disparities in BP control among SS have been uniformly unsuccessful.12 Multicomponent care models that include multidisciplinary approaches show promise for improving risk factor control after stroke.13, 14 Social determinants of health (SDOH) help to explain racial disparities in BP control and stroke recurrence, therefore multidisciplinary post-stroke care models that target SDOH may be key to decreasing disparities in BP control.5, 7, 15 Limited access to post-stroke outpatient care contributes to challenges in developing system-level interventions for post-stroke BP control. Telemedicine and telemonitoring may be ideal approaches for improving access to care in SS. The COVID-19 pandemic has led to rapid expansion of telemedicine for post-acute care in stroke survivors; however, its effectiveness is unproven. Based on preliminary data at our center, we propose a randomized trial testing an integrated multidisciplinary telehealth intervention, the Video-based Intervention to Reduce Treatment and OUtcome Disparities in Adults Living with Stroke or Transient Ischemic Attack (VIRTUAL), in SS recently discharged home after inpatient hospitalization for ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The intervention will include post-discharge telehealth visits by a multidisciplinary team, social risk assessments to facilitate social risk-targeted and social risk-informed care, and home BP telemonitoring and management. The care team includes neurology providers (physician and nurse practitioner), a pharmacist, and a social worker. Standard care will include follow-up with a neurologist and primary care provider and pharmacist-assisted BP adjustment. We aim to assess 1) the impact of the intervention on BP control 6 months following stroke assessed with ambulatory BP monitoring; 2) the impact of the intervention on recurrent vascular events 1 year after stroke; 3) the impact of the intervention on health services access and utilization following stroke; 4) moderating effects of race / ethnicity on the impact of the intervention on BP control, vascular events, and health services utilization; 5) the relationship between additional measured SDOH and primary and secondary outcomes.

IC Name
National Institute on Minority Health and Health Disparities
  • Activity
    R01
  • Administering IC
    MD
  • Application Type
    1
  • Direct Cost Amount
    418285
  • Indirect Cost Amount
    234240
  • Total Cost
    652525
  • Sub Project Total Cost
  • ARRA Funded
    False
  • CFDA Code
    307
  • Ed Inst. Type
    SCHOOLS OF MEDICINE
  • Funding ICs
    NIMHD:652525\
  • Funding Mechanism
    Non-SBIR/STTR RPGs
  • Study Section
    HSQE
  • Study Section Name
    Health Services: Quality and Effectiveness Study Section
  • Organization Name
    UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
  • Organization Department
    NEUROLOGY
  • Organization DUNS
    800771594
  • Organization City
    HOUSTON
  • Organization State
    TX
  • Organization Country
    UNITED STATES
  • Organization Zip Code
    770305400
  • Organization District
    UNITED STATES