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Abstract Details

Patient-reported outcomes in the Telehealth After Stroke Care feasibility randomized clinical trial: home blood pressure telemonitoring-enhanced versus usual post-acute stroke care in an underserved setting
Cerebrovascular Disease and Interventional Neurology
S20 - Cerebrovascular Disease and Interventional Neurology: Clinical Trials and Outcomes Studies (4:54 PM-5:06 PM)
008

Patient burden contributes to suboptimal outcomes among underserved populations. In addition to clinical outcomes, PROs can assess the impact of patient illness and associated interventions on perceived well-being. We developed a multidisciplinary team-based model integrated with remote BP monitoring and individualized visual education to improve post-stroke care resulting in substantial BP reduction, especially among Hispanic and non-Hispanic Black patients.

To determine the feasibility of incorporating patient-reported outcomes (PROs) into routine care among Telehealth After Stroke Care (TASC) study participants and to explore the effect of a team-based remote blood pressure (BP) monitoring program on psychological distress, quality of life and health activation.

The study leveraged five survey measures to evaluate PROs in control (n=25) and TASC arms (n=25): Patient Reported Outcomes Measurement Information System (PROMIS) Self Efficacy, Patient Activation Measure (PAM), Neuro-QOL (Quality of Life) Cognition and Depression, and Patient Health Questionnaire-9 (PHQ-9). Data were collected through a tablet provided to patients integrated with the electronic medical record. Patients who did not complete the surveys via tablet were contacted via telephone or e-mail. PROs were evaluated for difference in change over the study course between the two arms using simple linear regression.  

Of the fifty patients, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanism of survey submission included tablet (62% vs 47%), phone (24% vs 37%), tablet/phone combination (10% vs 16%), and e-mail (4% vs 0%), respectively.  There was a trend for reduction in depressive symptoms with PHQ-9 (p=0.06) in TASC arm. No significant differences were observed in PROMIS (p=0.67), PAM (p=0.71), or NeuroQoL measures (p=0.91, p=0.98).

Our findings suggest feasibility of incorporating PROs to rigorously evaluate a quality improvement intervention. It supports the concept of self-management through interactive web-based platforms. Patients equipped with appropriate resources can engage in post-stroke care to mitigate inequities in health outcomes.  

Authors/Disclosures
Imama Ali Naqvi, MD (Columbia University)
PRESENTER
Dr. Naqvi has nothing to disclose.
Hanlin Li, Other (NewYork-Presbyterian Hospital) Dr. Li has nothing to disclose.
Kevin Strobino (Columbia University) Mr. Strobino has nothing to disclose.
Kevin Schmitt (NewYork-Presbyterian Hospital) Mr. Schmitt has nothing to disclose.
Yuliya Baratt, PharmD, BCPS Dr. Baratt has nothing to disclose.
Carmen Elisabeth Castillo, Other (Columbia University) Mrs. Castillo has nothing to disclose.
Adriana Arcia, PhD,RN (Columbia University School of Nursing) Dr. Arcia has received personal compensation for serving as an employee of Columbia University. The institution of Dr. Arcia has received research support from National Institutes of Health. The institution of Dr. Arcia has received research support from Agency for Healthcare Research & Quality. The institution of Dr. Arcia has received research support from Alzheimer's Association. Dr. Arcia has received personal compensation in the range of $500-$4,999 for serving as a Consultant with RAND Corporation.
Ian Kronish, MD (Columbia University) Dr. Kronish has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Current Cardiology Report. The institution of Dr. Kronish has received research support from National Institutes for Health. The institution of Dr. Kronish has received research support from Agency for Healthcare Research and Quality.
Mitchell S. V. Elkind, MD, MS, FAAN Dr. Elkind has received personal compensation for serving as an employee of American Heart Association. Dr. Elkind has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Atria Academy. The institution of Dr. Elkind has received research support from BMS-Pfizer Alliance for Eliquis. The institution of Dr. Elkind has received research support from Roche. Dr. Elkind has received publishing royalties from a publication relating to health care. Dr. Elkind has a non-compensated relationship as a Officer with American Heart Association that is relevant to AAN interests or activities.