Promoting Self-Management in Stroke Survivors Using Health Information Technology (Minnesota)

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Summary:

Stroke survivors have a strong risk of recurrent stroke, heart attack, and heart failure due to the high prevalence of comorbid hypertension (HTN), diabetes, and elevated cholesterol. Post-discharge, stroke care is fragmented and inconsistent. Survivors tend to have poor risk factor management and medication adherence, leading to the risk of recurrence. Interventions to improve HTN control and medication compliance can prevent hospital readmissions and ultimately decrease costs of medical care.

The goal of this study was to test usability, feasibility, and efficacy of the American Heart Association’s Heart360, a mobile health technology (mHealth) tool used to facilitate HTN self-management among stroke survivors. Heart360 serves as a personal health record (PHR): when patients receive text message reminders their response is uploaded to it as health data. The researchers used Heart360 to evaluate self-management tasks and medication therapy management for HTN control among stroke survivors.

The specific aims of the project were as follows:

  • Examine Heart360 usability by stroke survivors or their caregivers for self-management tasks, including daily blood pressure (BP) monitoring, communication with providers, and medication management. 
  • Characterize rates of HTN control into guideline recommended ranges at 3 months after enrollment in the Heart360 group versus the usual care group. 
  • Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. 

In this randomized controlled trial, stroke survivors in the intervention group measured their BP and uploaded data into the Heart360 health management tool via text message. Study investigators sent the intervention group recommended medication adjustments based on their 7-day BP averages. Control subjects received usual care consisting of a home BP monitor and an American Stroke Association booklet on HTN and stroke. Study outcomes indicated good usability and feasibility of Heart360 for HTN management after stroke. Intervention participants showed significant improvement in HTN control compared to the usual care control group. Researchers recommend future studies to evaluate the effectiveness of this technology on a larger scale in populations, including both stroke survivors and those at high risk of stroke and cardiovascular events.

Promoting Self-Management in Stroke Survivors Using Health Information Technology - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-269: Exploratory and Developmental Grant to Improve Health Care Quality through Health Information Technology (IT) (R21)
  • Grant Number: 
    R21 HS 021794
  • Project Period: 
    September 2012 – September 2014
  • AHRQ Funding Amount: 
    $298,577
  • PDF Version: 
    (PDF, 299.12 KB)

Summary: Stroke survivors have a greater prevalence of the vascular risk factors of hypertension (HTN), diabetes mellitus, and elevated cholesterol than does the general population. They are thus at high risk of post-stroke hospital readmissions for recurrent stroke, heart attacks, and heart failure. Two-thirds of stroke survivors have residual disabilities and are frequently dependent on caregivers for transportation to and from clinic visits. Interventions to improve medication compliance and reduce caregiver burden may reduce hospital readmissions, improve outcomes, and ultimately decrease costs of medical care for stroke survivors.

This project demonstrates the use of an online health management tool for self-management tasks and medication therapy management (MTM) for HTN control in stroke survivors. The study design is a two-group parallel randomized controlled trial with the intervention group assigned to the online health management tool and the control group assigned to usual care. Stroke survivors in the intervention group self-measure blood pressure (BP) and upload the information into the American Heart Association Heart360 online health management tool. BP measurements are reviewed weekly by a provider and MTM advice is provided online. The control group receives the American Stroke Association booklet on the relationship between high BP and stroke as well as a home BP monitor.

Specific Aims:

  • Examine system usability by stroke survivors and/or their caregivers for self-management tasks including daily BP monitoring, communication with providers, and medication management. (Ongoing)
  • Characterize rates of HTN control into guideline recommended ranges at 3 months after enrollment in the online health management tool group versus the usual care group. (Upcoming)
  • Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. (Upcoming)

2012 Activities: Dr. Lakshminarayan and her team received institutional review board approval. Additionally, the research team began setting up multiple systems for the intervention and data collection elements of the study. Dr. Lakshminarayan has nearly completed negotiations with Verizon to provide hardware for the study. The team has also been working with the Clinical and Translational Science Institute at the University of Minnesota to determine which secure database system is best for data collection. The project team is currently holding meetings every other week and is developing the BP management protocols. A patient recruitment structure has been identified and the next phase of the project will be recruiting patients to participate. Focus groups to gather information on ease of participating have already been conducted, but it remains to be seen if recruitment will pose a challenge.

As last self-reported in the AHRQ Research Reporting System, activities are completely on track and project budget spending is on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Adults, Chronic Care*, Hypertension, Stroke

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Implementation and Use

*This target population is one of AHRQ’s priority populations.

Promoting Self-Management in Stroke Survivors Using Health Information Technology - Final Report

Citation:
Lakshminarayan, K. Promoting Self-Management in Stroke Survivors Using Health Information Technology - Final Report. (Prepared by the University of Minnesota under Grant No. R21 HS021794). Rockville, MD: Agency for Healthcare Research and Quality, 2015. (PDF, 180.67 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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