Adapting Tools to Implement Stroke Risk Management to Veterans (TOOLS)

The purpose of this study is to 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 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.

Stroke affects at least 15,000 veterans each year, and this number will likely increase as the veteran population ages. According to the AHA, the prevalence of stroke is expected to double by 2020 with the increased proportion of older adults nationwide. Our preliminary QUERI work indicates that stroke risk factors are often undermanaged in VHS.

This proposed study of a stroke risk factor management program may benefit the VHS in several ways. First, it offers VHS 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 VSPP 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/DoD, AHA, and JCAHO 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.

• Ischemic Stroke
• Transient Ischemic Attack

• Behavioral: Physician stroke guideline adherence
  Interviewing Providers, conducting Focus Groups
• Behavioral: Evaluation of stroke self management
  Implementing a Peer/Mentoring Program for Stroke Survivors

Inclusion Criteria:

• Veterans 18 years or older hospitalized with stroke or TIA at Indianapolis VAMC and Houston VAMC;
• willing to participate;
• access to telephone;
• speaks and understands English;
• no severe cognitive impairments;
• life expectancy of at least 6 mos;
• willingness to follow-up in VA outpatient care.

Exclusion Criteria:

• Severe aphasia or cognitive impairment;
• active alcohol or substance abuse;
• cannot or unwilling to participate;
• does not speak or understand English;
• life expectancy less than 6 mos;
• no access to telephone;
• no VA outpatient follow-up.