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BACKGROUND/RATIONALE:
Hypertension is a common modifiable risk factor for stroke. A large body of evidence demonstrates that lowering blood pressure reduces stroke risk substantially. Racial disparities in stroke risk factors, particularly in the control of hypertension, have been demonstrated such that Blacks have worse blood pressure control than Whites both within and outside of the VA system.
OBJECTIVE(S):
The primary aims of this proposal are to examine whether racial differences exist in the management of blood pressure: (1) in the one-year prior to hospitalization for acute ischemic stroke, (2) in the acute stroke period (the first 48 hours after admission to the hospital), (3) at the time of discharge from the hospital, and (4) in the one year after discharge from the stroke hospitalization.
METHODS:
This project includes three components: (a) a secondary analysis of an ongoing retrospective cohort study entitled “Quality Evaluation in Stroke and Transient Ischemic Attack” (QUEST), (b) a medical record review of veterans included in the QUEST project including data from the one year pre-stroke and one year post-stroke, (c) the identification of barriers and opportunities to improving blood pressure managment and the development of rapid cycle implementation strategies that will facilitate the implementation of programs to address any identified gaps or disparities in blood pressure care within the VA sites.
The primary outcomes will be median systolic and diastolic blood pressure, and median anti-hypertensive medication dose in the one year pre-stroke, at discharge, and in the one-year post stroke. The secondary outcomes will include: the proportion with guideline adherent blood pressure management during the acute stroke period; the mean number of primary care visits in the one year pre-stroke and in the one-year post stroke; the proportion with prosthetics consults for home blood pressure monitor devices; the proportion with clinician documented reasons for poor blood pressure control; and the proportion with recurrent vascular events or death within the one-year post-stroke.
Among 1487 patients in the final QUEST cohort; approximately 350 are veterans, and approximately 15% of the veterans are Black, whereas 20% of the non-veterans are Black. The primary analysis for this proposed project will be a comparison of blood pressure management between blacks and non-blacks both within the VA. The secondary analyses will be a comparison of blood pressure management (a) overall between the VA and non-VA sites, (b) a race-based comparison between the VA and non-VA sites, and (c) a comparison between those in care at the VA pre-stroke versus those not in care at the VA pre-stroke.
FINDINGS/RESULTS:
None at this time.
IMPACT:
This proposal focuses on the evaluation of blood pressure management in both the acute stroke setting and the outpatient setting, assessing whether blood pressure management guidelines are being implemented equally across races. Data from this proposed project will be used to identify opportunities to implement future programs to address any racial disparities in care that exist in three VA medical centers. These data will serve to guide future implementation projects to improve blood pressure management for veterans with cerebrovascular disease, beyond the quality improvement efforts that are already ongoing within the VA primary care service. Opinion leaders at the three VA medical centers will be informed of any gaps in care or racial disparities in care that are identified at their site. Interventions to improve any identified disparities in care will be developed as part of this RRP but the evaluation of these programs will not be included in this proposed project.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Quality of Care, Prevention
Keywords:
Ethnic/cultural, Stroke, Hypertension
MeSH Terms:
none
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