Hypertension Improvement Pilot Intervention in Post-Stroke Veterans

NIH RePORTER · VA · I21 · · view on reporter.nih.gov ↗

Abstract

Background: Over 6,000 Veterans are admitted with an acute ischemic stroke annually within the VA Healthcare System. Nearly 25% of all strokes are recurrent events and constitute a leading cause of disability and death within our Veteran population, especially among the 75% of Veterans with stroke and hypertension. Current VA/DoD and American Heart Association/American Stroke Association (AHA/ASA) guidelines stress the importance of delivering guideline concordant management of hypertension, given the strong association between goal blood pressure and decreased morbidity and mortality, especially during the six-month post- stroke period, when most stroke and non-stroke related hospitalizations and deaths occur. Previous Quality Enhancement Research Initiative (QUERI) work has shown that many Veterans 6-months after their stroke do not have their blood pressure optimally controlled. Most Veterans receive their post-stroke risk hypertension care within VA Primary Care and Patient Aligned Care Teams (PACTs). Work performed during the current Health Services Research and Development (HSR&D) Career Development Award (CDA) period has identified several areas for intervention that can assist outpatient providers in Primary Care/PACT to better manage hypertension using existing VA infrastructure, and has led to the development of a bundled, evidence-based, `Post Stroke Hypertension Improvement Intervention.' Therefore, focusing on prevention of future strokes by implementing an intervention to effectively treat hypertension among Veterans with stroke is necessary to improve outcomes in this population. Objective: To: (1) evaluate the feasibility and acceptability of a pilot intervention, implemented at a single VAMC providing suboptimal blood pressure management to post-stroke Veterans, during the `high-risk,' 6- month period post-stroke, such that a more refined intervention can be developed and further informed by key stakeholders, end users, and strategic partners; and (2) collect metrics related to hypertension control at the intervention and four control sites. Methods: A pilot will be initiated at the Michael E. DeBakey VAMC. The Consolidated Framework for Implementation Research (CFIR) conceptual framework and Systems Redesign strategies will be used to evaluate the implementation of the intervention. The feasibility and acceptability of the implementation strategy will be assessed via qualitative interviews with end users of the intervention. Blood pressure will be measured at baseline, 3-months, and 6-months. The distributions and central tendencies of baseline demographic and patient-, provider-, and facility-level characteristics for continuous variables will be examined graphically and by summary statistics. Categorical variables will be examined by calculating frequency distributions. We will match, based on patient volume and mean facility-level blood pressure, our intervention and control sites. Hypothesis: We believe that we can: (1) dete...

Key facts

NIH application ID
9982060
Project number
5I21HX002091-02
Recipient
VA CONNECTICUT HEALTHCARE SYSTEM
Principal Investigator
Jason Jonathon Sico
Activity code
I21
Funding institute
VA
Fiscal year
2020
Award amount
Award type
5
Project period
2017-09-01 → 2019-02-28