IMPORTANCE Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. OBJECTIVE To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention

URL: https://clinicaltrials.gov. Unique identifier: NCT00861081.

Background: Effective interventions to improve stroke preventative care in vulnerable populations have not been reported. Methods: We tested the impact of a chronic care model-based intervention program among 407 subjects with a recent stroke or transient ischemic attack at four Los Angeles County public hospitals. All subjects had a baseline systolic blood pressure (SBP) of at least 120 mm Hg and were randomized after baseline assessment in a 1:1 ratio to usual care or intervention, stratified by hospital and by English/Spanish language. The care management intervention was led by bilingual nurse practitioners or physician assistants, and it consisted of group clinics, self-management support, report cards, decision support, and coordination of ongoing care. Intention-to-treat analyses were conducted using repeated-measures mixed-effects models. The primary outcome was change in SBP. Secondary outcomes were other measures of SBP, low-density lipoprotein (LDL), ACC/AHA 10-year cardiovascular risk, adherence to antihypertensive and to antithrombotic medications, and physical activity. Results: Mean age was 57 years, 60% were male, 18% were African-American race, and 69% were Hispanic ethnicity. 48% had not graduated from high school. Baseline SBP was 150 mm Hg in the usual care arm and 149 mm Hg in the intervention arm. 12 month data were obtained in 333 participants (82%). There were substantial declines in SBP in both the usual care and intervention arms (Table). However, there were no significant differences between the two arms in either improvement of SBP from baseline or other measures of stroke risk factor control. Subgroup analyses did not reveal a differential impact of the intervention by race/ethnicity. Conclusion: Our care management intervention did not improve stroke risk factor control beyond what was attained in usual care. Further analyses are ongoing, and those findings will be used to guide modification of the intervention for future testing.