Adapting Tools to Implement Stroke Risk Management to Veterans "TOOLS"

Completed

Phase N/A Results

Trial Description

The purpose of this study is to develop and evaluate the local adaptation of existing stroke prevention tools into practice. A stroke prevention program is a collection of materials including written materials like pamphlets and brochures, videotapes and training guides for stroke survivors and evidence based guidelines for the doctors that provide care for them. Other tools that may be used in a stroke prevention program include devices that help patients monitor medical symptoms at home like home blood pressure machines or blood sugar monitors and messaging devices that allow reporting symptoms from home to a health care provider.
We hypothesized Veterans with stroke who receive the Veteran Stroke Prevention Program would engage in better medication compliance and stroke specific quality of life compared to those who did not receive the program.

Detailed Description

Stroke affects at least 15,000 veterans each year, and this number will likely increase as the veteran population ages. According to the American Heart Association, the prevalence of stroke is expected to double by 2020 with the increased proportion of older adults nationwide. Our preliminary Quality Enhancement Research Initiative work indicates that stroke risk factors are often undermanaged in the Veterans Health Administration.
This proposed study of a stroke risk factor management program may benefit the Veteran Health System in several ways. First, it offers a systematic program for reduction in stroke risk factors leading to better health for our veterans and a reduction in inpatient and outpatient rehabilitation and home health services for these events. Second, the Veteran Stroke Prevention Program takes into account the varied resources and services offered in VAMCs across the nation, allowing the program to be tailored both to a given facility and to the individual veteran's needs and readiness to change. Importantly, the program could allow all VA facilities to offer guideline-concurrent stroke risk reduction programs and therefore increase compliance with VA/Department of Defense, American Heart Association, and the Joint Commission stroke care guidelines and improve their quality of stroke care.
Comparison(s): We will compare two regionally matched facilities on rates of secondary stroke prevention guideline care during the course of the study at the intervention sites.

Conditions

Interventions

  • Stroke Prevention Program Other
    Intervention Desc: a collection of materials including written materials like pamphlets and brochures, videotapes and training guides for stroke survivors and for the doctors that provide care for them. Other tools that may be used in a stroke prevention program include things that help patients monitor medical symptoms at home like home blood pressure machines or blood sugar monitors and messaging devices that allow reporting symptoms from home to a health care provider.
  • Physician stroke guideline adherence Behavioral
    Intervention Desc: Provided clinicians with Secondary Stroke Prevention Guidelines/Posted near workstations for Discharge Planning and Provided Clinicians with Seminar on Motivational Interviewing and Goal Setting to Modify Patient Health Behaviors
    ARM 1: Kind: Experimental
    Label: 1
    Description: None
    ARM 2: Kind: Experimental
    Label: Arm 1
    Description: None
    ARM 3: Kind: Experimental
    Label: Arm 1 Secondary Risk Factor Management
    Description: Patient Secondary Stroke Risk Factor Program including Stroke Self Management and Stroke Peer Support and Physician Stroke Guideline Adherence
  • Evaluation of stroke self management Behavioral
    Intervention Desc: Implementing a Peer/Mentoring Program for Stroke Survivors
    ARM 1: Kind: Experimental
    Label: 1
    Description: None
    ARM 2: Kind: Experimental
    Label: Arm 1
    Description: None
  • Stroke Self Management Behavioral
    Intervention Desc: Provided Post Stroke Guidelines on Secondary Prevention to Clinicians Preparing Discharge Plans; Provided Secondary Stroke Self-Management and Stroke Peer Support to Veteran Patients with Stroke/TIA
    ARM 1: Kind: Experimental
    Label: Arm 1 Secondary Risk Factor Management
    Description: Patient Secondary Stroke Risk Factor Program including Stroke Self Management and Stroke Peer Support and Physician Stroke Guideline Adherence

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Subject, Outcomes Assessor)
  • Purpose: Health Services Research
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Patient Involvement

Follow stroke guideline adherent treatment, risk factor behavior self-management at stroke discharge, 3 and 6 months.

Outcomes

Type Measure Time Frame Safety Issue
Primary Provider based outcomes - guideline adherent treatment, medication management at stroke discharge, 3 and 6 mos. Risk factor screening, examination of CPRS records during hospitalization or following 6 mos. Lifestyle counseling, examination of CPRS record
Secondary Patient demographics, BL; depression symptoms at BL, 3 & 6 mos; other co morbidities at 6 mos
Primary Provider based outcomes: guideline adherent treatment, medication management at stroke discharge, 3 and 6 mos. Risk factor screening, examination of CPRS records during hospitalization or following 6 mos. Lifestyle counseling, examination of CPRS records One year No
Secondary Patient demographics, BL; depression symptoms at BL, 3 & 6 mos; other co morbidities at 6 mos. One year No
Primary Stroke Specific Health Related Quality of Life 6 months for (SSQoL) and 3 months for Perceived Energy Subdomain No
Primary Self-Efficacy to Manage Stroke Symptoms 6 months No
Secondary Medication (Diabetes) Compliance for Secondary Stroke Prevention Risk Factor Managment baseline, 6 months No
Secondary Medication (Statins) for Secondary Stroke Prevention Risk Factor Management baseline, 6 months No
Secondary Medication (Hypertension) Compliance for Secondary Stroke Prevention Risk Factor Management Baseline, 6 months No

Sponsors