Research examines impact of social determinants on stroke
A trial testing whether multidisciplinary telehealth intervention will help improve racial disparities in outcomes for adult stroke survivors will be launched at The University of Texas Health Science Center at Houston (UTHealth Houston) with a $3.1 million grant from the National Institute on Minority Health and Health Disparities at the National Institutes of Health.
The study – led by Anjail Z. Sharrief, MD, MPH, associate professor of neurology with McGovern Medical School – marks a collaborative effort among Cizik School of Nursing at UTHealth Houston, UTHealth School of Public Health, UTHealth Houston School of Biomedical Informatics, and UTHealth Houston Institute for Stroke and Cerebrovascular Disease.
The research team aims to reduce existing racial disparities in blood pressure control and stroke recurrence among stroke survivors by using telemedicine and telemonitoring to target key social determinants of health, such as health care access, food insecurity, housing insecurity, access to transportation, and language preferences.
“There are a lot of gaps in knowledge related to how to best treat patients following stroke. We don’t often enough think about social factors and how they impact outcomes,” Sharrief said. “Essentially, we know that disparities exist, but we don’t know what causes them and how to address them. With this study, we hope to have more information about what causes these disparities and potential ways to address them.”
Hypertension is the most important risk factor for ischemic and hemorrhagic stroke, and reduction in blood pressure after stroke is associated with reduced risk of stroke recurrence. However, for the majority of stroke survivors, hypertension remains poorly controlled early after a stroke. In the U.S., Black and Hispanic stroke survivors are more likely to have poorly controlled risk factors after stroke compared to white stroke survivors.
Sharrief sees promise in telehealth as a means for closing these gaps for several reasons. On the care side, the style of intervention facilitates a multidisciplinary team approach by making it easier for multiple medical providers to get together at the same time and meet with their patient. It also removes certain barriers for patients who may not have reliable access to transportation or who may not be able to pay for parking, among other issues.
Overall, the randomized trial will compare outcomes between two groups of patients – one assigned to participate in the VIRTUAL intervention (Video-based Intervention to Reduce Treatment and Outcome Disparities in Adults Living with Stroke or Transient Ischemic Attack), and the other to standard care.
The VIRTUAL intervention will include post-discharge telehealth visits with a multidisciplinary team, social risk assessments to facilitate social risk-targeted and social risk-informed care, and home blood pressure telemonitoring and management. Patients will be followed by a care team consisting of neurology providers (physician and nurse practitioner), pharmacists, and a social worker. Standard care will include follow-up with a neurologist and primary care provider and pharmacist-assisted blood pressure adjustment.
Specifically, Sharrief will assess the impacts of the telehealth intervention on blood pressure control six months following stroke, recurrent vascular events one year after stroke, and health services access and utilization following stroke, as well as the moderating effects of race and ethnicity on these outcomes. The team will also determine the relationship between additional measured social determinants of health and outcomes.
The research team also includes McGovern Medical School faculty Olasimbo Chiadika, MD, associate professor of cardiovascular medicine; Charles Green, PhD, associate professor in the Department of Pediatrics; Sean Savitz, MD, professor and the Frank M. Yatsu, MD, Chair in Neurology; and Elmer Bernstam, MD, professor of internal medicine who is also The Reynolds and Reynolds Professor in Clinical Informatics at the School of Biomedical Informatics. Team member Munachi Okpala, DNP, is a nurse practitioner with McGovern Medical School. Daphne Hernandez, PhD, the Lee and Joseph Jamail Distinguished Professor in the School of Nursing at Cizik School of Nursing, and Jose-Miguel Yamal, PhD, professor of biostatistics and data science at the School of Public Health, are also on the team. Savitz is director of the Institute for Stroke and Cerebrovascular Disease, and Green, Hernandez, Okpala, Yamal, and Sharrief are members. Savitz, Bernstam, and Yamal are members of The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences.
The researchers will begin recruiting patients for the study in early 2022. They hope to enroll approximately 540 patients.