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Center for Stroke Disparities Solution - Community Transitions Intervention (CSDS)

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ClinicalTrials.gov Identifier: NCT01918891
Recruitment Status : Completed
First Posted : August 8, 2013
Last Update Posted : October 1, 2019
Sponsor:
Collaborators:
National Institute of Neurological Disorders and Stroke (NINDS)
NYU Langone Health
Hebrew Home at Riverdale
Columbia University
Information provided by (Responsible Party):
Visiting Nurse Service of New York

Brief Summary:
The Stroke CTI study is a 3 arm randomized, controlled trial designed to assess the effectiveness of a nurse practitioner (NP) only and a NP and health coach (HC) community transitions intervention (CTI) in reducing secondary stroke risk by helping patients lower their systolic blood pressure.

Condition or disease Intervention/treatment Phase
Hypertension Stroke Transient Ischemic Attack Behavioral: Nurse Practitioner Only Behavioral: Nurse Practitioner + Health Coach Not Applicable

Detailed Description:
Targeted study participants are Black and Hispanic patients with a history of stroke and a current systolic blood pressure (BP) above JNC7 recommended range (>=140 mmHg) who recently entered home care service. The NP only program will provide a 30 day intervention while the NP/HC team will provide 3 months of support via in-home and telephone encounters for patients randomized to one of these groups. In the first 30 days post-enrollment the NP will focus on medical case management and coordination with primary care providers and specialists, provide self-management coaching, and intervene if gaps in care are identified - all with a focus on BP reduction and preparing the patient for ongoing BP maintenance. As applicable, the HC will pick up the case after 30 days and follow up with the plan of care jointly established by the patient, NP and HC. The focus will be on ongoing self-management coaching, providing preparation support for physician visits, and linking patient to additional community resources, as needed.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 495 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Center for Stroke Disparities Solution (CSDS) Project II: Community Transitions Intervention (CTI)
Actual Study Start Date : September 2012
Actual Primary Completion Date : June 2018
Actual Study Completion Date : June 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
No Intervention: Usual Home Care
Regardless of study arm, all patients will receive usual home health services: a physician-ordered plan of care; skilled nursing and/or therapy services as prescribed by the MD; patient education, monitoring and hands-on care; and home health aide services depending on functional deficits and availability of unpaid caregivers.
Experimental: Nurse Practitioner + Health Coach
The NP + HC arm will include the same protocol as the NP only arm plus 30 additional days of support. The HC will pick up the case after the initial 30 days and follow up with the plan of care jointly established by the patient, NP and HC. The focus will be on ongoing self-management coaching, providing preparation support for physician visits, and linking patient to additional community resources, as needed.
Behavioral: Nurse Practitioner Only
Behavioral: Nurse Practitioner + Health Coach
Experimental: Nurse Practitioner Only
The NP only program will provide a 30 day intervention via in-home and telephone encounters for patients randomized to this group. In the first 30 days post-enrollment the NP will focus on medical case management and coordination with primary care providers and specialists, provide self-management coaching, and intervene if gaps in care are identified - all with a focus on BP reduction and preparing the patient for ongoing BP maintenance.
Behavioral: Nurse Practitioner Only



Primary Outcome Measures :
  1. Reduction of systolic blood pressure [ Time Frame: Baseline to 3 and 12 months. ]
    Patients randomized to the NP only and the NP+HC transitional care interventions will have greater 3 and 12 month reduction in SBP than patients in Usual Home Care.


Secondary Outcome Measures :
  1. Cost-effectiveness of NP-only and NP+HC relative to UHC [ Time Frame: VNSNY home care admission to 3 and 12 months post admission ]
    Both interventions will be more costly but more cost-effective than usual home care.

  2. Influence on post-stroke patients' function and health-related quality of life (QoL) [ Time Frame: Baseline to 3 and 12 months ]
    Both interventions will yield significant comparative improvements in function and health-related QoL; NP+HC will be more effective than NP-only.


Other Outcome Measures:
  1. Moderators and mediators that may affect treatment outcomes [ Time Frame: Baseline to 3 and 12 months ]
    Exploratory aim to examine potential moderating/mediating variables which may include: moderators - race/ethnicity (i.e., Black/Hispanic differences), baseline HTN severity (Stage I vs. Stage II); mediators - 1) changes in health behaviors (i.e., diet, physical activity, weight loss, medication adherence); and 2) antihypertensive medication intensification (i.e., adding, changing dose, or changing class of medications).



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Ages Eligible for Study:   21 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Newly admitted to the VNSNY post acute care program
  • 21 years of age or older
  • Black and/or Hispanic
  • Speaks English or Spanish
  • History of stroke or transient ischemic attack (TIA)
  • Hypertension diagnosis
  • Average screening systolic BP >= 140 mmHg
  • Is available to participate in intervention activities during the study timeframe if randomized to treatment group

Exclusion Criteria:

  • Dialysis
  • End stage renal disease
  • Kidney transplant
  • Severe heart failure
  • Significant cognitive impairment. Unable to provide informed consent, accurate self-report, and/or unable to participate effectively in intervention
  • Significant verbal speech impairment. Unable to participate in intervention telephone sessions
  • Patients with upper arm circumference outside of valid use parameters for the automated device used for eligibility screening

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01918891


Locations
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United States, New York
Visiting Nurse Service of New York
New York, New York, United States, 10001
Sponsors and Collaborators
Visiting Nurse Service of New York
National Institute of Neurological Disorders and Stroke (NINDS)
NYU Langone Health
Hebrew Home at Riverdale
Columbia University
Investigators
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Principal Investigator: Penny H Feldman, PhD Visiting Nurse Service of New York
Additional Information:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Visiting Nurse Service of New York
ClinicalTrials.gov Identifier: NCT01918891    
Other Study ID Numbers: I12-004
1U54NS081765 ( U.S. NIH Grant/Contract )
First Posted: August 8, 2013    Key Record Dates
Last Update Posted: October 1, 2019
Last Verified: September 2019
Keywords provided by Visiting Nurse Service of New York:
stroke
transient ischemic attack
High blood pressure
Hypertension
Additional relevant MeSH terms:
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Stroke
Ischemic Attack, Transient
Hypertension
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Ischemia