CARES (Changing and Advancing Risk factor control through Educations after Stroke): A Pilot Trial of a Transitions in Care Post-discharge Telephone Intervention for Stroke Patients (S13.006)

OBJECTIVE: The purpose of study is to test the feasibility and effectiveness of a telephonic post-discharge intervention designed to improve access to care, reinforce self-management skills, improve health literacy, and screen for complications in a government-run safety net system. BACKGROUND: In the United States, risk factor control after stroke is poor, particularly among socio-economically disadvantaged populations with poor access to care. The immediate post-discharge period is a vulnerable time for stroke patients, given their risk of recurrent stroke, worsening symptoms, complications, and need for medication titration. The Los Angeles County Department of Health Services is the second largest public safety-net system in the United States, serving >700,000 people each year; over 90[percnt] are minorities and the majority lack health insurance. DESIGN/METHODS: This is a randomized controlled trial, recruiting 500 participants from two LAC-DHS hospitals. Inclusion criteria include ischemic or hemorrhagic stroke or transient ischemic attack (TIA), and English or Spanish-speaking. Exclusion criteria include severe aphasia without a proxy and out of county residents. The intervention consists of telephone calls administered at five intervals post-discharge: 2-4 days, 30 days, 90 days, 6 months, and 9 months. The call assesses and addresses access to care (appointment, financial clearance, transportation, medication refills), new stroke symptoms, self-management skills, complications (such as urinary tract infections and depression), therapy needs, stroke literacy, and lifestyle habits (smoking, alcohol use, physical activity and diet). OUTCOMES: The primary outcome is access to care. Secondary outcomes include patient experience, self-efficacy, stroke literacy, lifestyle habits, and control of blood pressure, cholesterol and diabetes. Assessments will be performed at baseline (prior to hospital discharge), 7-14 days, 60 days and 12 months post-discharge. Disclosure: Dr. Hudson has nothing to disclose. Dr. Corrales has nothing to disclose. Dr. Moreno has nothing to disclose. Dr. Valle has nothing to disclose. Dr. Razmara has nothing to disclose. Dr. Dutta has nothing to disclose. Dr. Ramirez-Gomez has nothing to disclose. Dr. Towfighi has nothing to disclose.