PRAISE: Preventing recurrence of all inner-city strokes through education;

赞扬：通过教育预防所有市中心中风的复发；

• 批准号: 8263003
• 负责人: Carol R Horowitz
• 金额: $ 85.65万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-05 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8263003
• 关键词: Address; Adherence; Adult; African American; Blood Pressure; Chronic; Chronic Disease; Church; Clinical; Color; Commit; Communities; Community Health Education; Community Hospitals; Community Outreach; Data; Education; Educational Intervention; Effectiveness; Event; Feedback; Fibrinolytic Agents; Funding; Generic Drugs; Health; Health Policy; Healthcare; Hospitals; Hyperlipidemia; Hypertension; Individual; Inpatients; Intervention; Knowledge; LDL Cholesterol Lipoproteins; Latino; Learning; Link; Low income; Medical; Medical center; Medicine; Minority; National Center on Minority Health and Health Disparities; Neighborhoods; Participant; Patient Education; Patients; Population; Prevalence; Prevention program; Prevention strategy; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Recurrence; Regimen; Relative Risks; Research; Research Personnel; Resources; Risk; Risk Factors; Sample Size; Self Management; Sister; Site; Stroke; Stroke prevention; Surveys; Survivors; Symptoms; Testing; Time; Transient Ischemic Attack; Trust; Ursidae Family; Work; acute stroke; base; community setting; cost; design; disorder prevention; experience; follow-up; health disparity; hypertension control; improved; inner city; meetings; member; novel; peer; post stroke; prevent; programs; randomized trial; skills; treatment as usual; treatment strategy

More than one fourth of the 700,000 strokes that occur annually in the US are among stroke survivors. Blacks, or African Americans, both nationally and in Harlem, NYC, have a twofold increase in recurrent strokes, and our data reveal that Latinos in Harlem, have a threefold increase in risk relative to Whites. The primary risk factors for recurrent stroke include hypertension, hyperlipidemia, and underuse of antithrombotic agents. Controlling these risk factors may be particularly challenging for low-income, minority populations who often lack the healthcare, financial and community support needed to adhere to necessary and lifelong therapies. In Harlem, 72% of adults studied six months post- stroke did not have these three risk factors treated adequately. Peer-led patient education initiatives may help stroke survivors better manage their risk factors. Such initiatives may prove to be effective, low cost, sustainable stroke prevention strategies within communities of color, whose residents bear a disproportionate burden of suffering due to strokes. Over the past decade, we have been conducting studies to understand and reduce the health disparities related to stroke and associated conditions in Harlem. We have also built strong relationships with community leaders in Harlem that help us develop culturally appropriate interventions. Our team adapted the Stanford Chronic Disease Self-Management Program, a peer-led course for adults with all chronic diseases, to help acute stroke survivors reduce their risks for recurrence. Early results of a randomized controlled trial to test its effectiveness demonstrate that 24% more intervention subjects had all three risk factors controlled, compared with those randomized to usual care. However, the sample size was limited, based on our inpatient recruitment approach. We aim to work with our community partners to employ a novel, community based recruitment strategy that they proposed. Through this strategy, we will identify 600 Black, Latino and White community-dwelling residents of Harlem who have had strokes or transient ischemic attacks the past within five years. We will then conduct and rigorously evaluate a randomized, controlled trial to determine if participation in this program improves the control of risk factors for stroke recurrence. Finally, if the trial is successful, we will work to sustain the program locally, disseminate the results nationally, and use the lessons learned to inform health policy.

在美国每年发生的 70 万例中风中，超过四分之一是中风幸存者。 黑人或非裔美国人，无论是在全国范围内还是在纽约市哈莱姆区，复发性癌症的数量增加了一倍 我们的数据显示，哈莱姆区的拉丁裔中风的风险比白人高出三倍。这 复发性中风的主要危险因素包括高血压、高脂血症和抗血栓药物使用不足 代理。对于低收入、少数族裔人群来说，控制这些风险因素可能尤其具有挑战性 他们往往缺乏坚持必要的、终身的医疗保健、财务和社区支持 疗法。在哈莱姆区，72% 的中风后六个月的成年人不存在这三个危险因素 得到充分治疗。同伴主导的患者教育举措可以帮助中风幸存者更好地管理他们的风险 因素。这些举措可能被证明是有效的、低成本的、可持续的中风预防策略。 有色人种社区，其居民因中风而承受着不成比例的痛苦。 在过去的十年中，我们一直在进行研究以了解和减少健康差距 与哈莱姆区的中风和相关病症有关。我们还与以下机构建立了牢固的关系： 哈莱姆区的社区领袖帮助我们制定适合文化的干预措施。我们的团队适应了 斯坦福慢性病自我管理计划，这是一个针对患有所有慢性病的成年人的同行主导课程 疾病，帮助急性中风幸存者降低复发风险。随机试验的早期结果 测试其有效性的对照试验表明，患有所有三种风险的干预对象增加了 24% 与随机接受常规护理的因素相比。但样本量有限， 基于我们的住院患者招募方法。 我们的目标是与社区合作伙伴合作，采用一种新颖的、基于社区的招聘策略， 他们提议。通过这一战略，我们将确定 600 个黑人、拉丁裔和白人社区住宅 过去五年内曾患过中风或短暂性脑缺血发作的哈莱姆区居民。我们将 然后进行并严格评估一项随机对照试验，以确定是否参与该试验 该计划改善了对中风复发危险因素的控制。最后，如果试验成功，我们将 努力在当地维持该计划，在全国传播结果，并利用吸取的经验教训 卫生政策。