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Stroke Prevention Programs Can Improve Outcomes by Addressing Treatment Inequities

Patient with Blood Pressure Cuff
Patient with Blood Pressure Cuff
Patient with Blood Pressure Cuff

Keck Medicine of USC Is Pioneering New Ways to Overcome Health Care Delivery Disparities in Stroke Prevention and Treatment

USC Neurology is dedicated to exploring innovative ways of delivering innovative preventive programs and optimal care to patients at risk for or who have had a stroke.

“Over 80 percent of all strokes can be prevented though changes in lifestyle and with existing medical care," says Keck Medicine neurologist Amytis Towfighi, MD, who is also a professor of neurology (clinical scholar) at Keck School of Medicine of USC.

“The goal is to provide access to excellent medical care, enhance self-efficacy, address social determinants of health, and support lifestyle changes in the underserved, because they are at the highest risk of stroke.”

To that end, Dr. Towfighi and colleagues have published two studies that address the inequities in health and health care throughout Los Angeles County. The studies tested novel models of health care delivery to overcome inequities in health.

“We are dedicated in figuring out how to reduce inequities and provide the best possible preventive stroke care to previously marginalized populations,” stresses Dr. Towfighi.

The first study, published in 2018 in Circulation: Cardiovascular Quality and Outcomes, was "Efficacy of a Chronic Care-Based Intervention on Secondary Stroke Prevention Among Vulnerable Stroke Survivors, A Randomized Controlled Trial.”

It tested the efficacy of components of a chronic care model-based intervention versus usual care among 404 subjects with an ischemic stroke or transient ischemic attack within 90 days of enrollment and receiving care within the Los Angeles public health care system.

The intervention included a nurse practitioner/physician assistant care manager, group clinics, self-management support, report cards, decision support, and ongoing care coordination. While the intervention did not reduce risk of a recurrent stroke, participants who received the intervention had better cholesterol control.

In order to address patients' social determinants of health and barriers, the research team decided to take health care into patients' homes. They created an intervention driven by in-home visits by community health workers who were culturally concordant with the majority of participants. The hope was that barriers to health care delivery could be overcome by in-home visits in this vulnerable population with coordinators who speak the primary language of our patients.

The results were published in 2021 in JAMA Open Access as “Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial.” The key takeaways from the study were:

  1. Stroke prevention in the underserved requires a high level of coordinated care but remains the most efficient way to reduce the societal burden of stroke.
  2. Although the model used in the study did not show statistical significance in achieving the stroke prevention metrics like BP control, participants reported better satisfaction with their care, and said their health care team was willing to listen to them and explained things in a way that they could understand.
  3. Engaging our population is the means to empower them to improve their health, and we need to provide a system of care to support this.
  4. Interventions that address the upstream social determinants of health (like housing, employment, and food insecurity) are likely warranted to reduce inequities.

As a result of these efforts, the team has become more aware that individual patient's social and environmental factors affect their ability to engage with follow-up and prevention. They have put into place more call-backs and greater engagement post-discharge to improve stroke prevention. And to increase the effectiveness of stroke prevention in high-risk groups, the program has been awarded follow-up grants to prevent stroke in a more early time period, well before the stroke risk factors develop for these vulnerable groups.

At USC Neurology, acute and preventive care for stroke and neurocritical illness is provided by 17 faculty members in the division as well as six physician-fellows and five staff members. In addition, the USC Roxanna Todd Hodges Comprehensive Stroke Center and TIA Program brings together a diverse, specialized team of health professionals to provide the most advanced and comprehensive care to patients who have experienced stroke or acute neurological events and related conditions.

To Refer a Patient to Keck Medicine of USC

To consult with a neurology clinician or refer a patient to USC Neurology, call (323) 442-5710. For urgent matters or if calling after business hours, please call (800) USC-CARE (800-872-2273).