Jane A. Anderson PhD, RN, FNP-BC and Thomas A. Kent MD Anjail Sharrief, MD, MPH Johanna Morton, MD Robin Brey, MD V-STOP II V ideo Teleconference Technology to Implement Patient S elf-management TO P revent Stroke

V-STOP II & the Texas Plan to Reduce Cardiovascular Disease & Stroke Goal 1: Strategies that Support/Reinforce Healthy Behavior Goal 2: Community - Clinical Linkages Enhancements Goal 3: Health Systems Interventions

Stroke Risk Factor Control Lifestyle Behavior Change Clinical Management Therapy / Ischemic Stroke Etiology Thrombotic – Carotid Intervention/Antiplatelets Cardioembolic – Anticoagulation HTN, DM, Hyperlipidemia, Obesity Meet Target Values for BP – A1c – LDL – BMI Patient Education & Self-management Smoking Cessation - Health Diet - Physical Activity - Decrease Alcohol Consumption The V-STOP Intervention

Feasibility of Providing Videoteleconference Self-management TO Prevent Stroke A risk factor reduction program for patient with stroke or TIA Previously tested within the VA’s telehealth network Shown to improve: – Access to specialty care services – Stroke risk knowledge – Physical and emotional quality of life – Self-management behaviors – Communication with health care providers

Study Design Pilot study within the Lone Star Stroke VT network to deliver the V-STOP program. Four LSS hubs deliver V-STOP II in 2 spoke sites. V-STOP II will be delivered across 8 outpatient facilities in Texas.

Patient Criteria History of stroke and/or TIA within 6 months Two or more uncontrolled stroke risk factors – BP > 140/90 – HgA1C > 7 – LDL-C > 100 * based on high risk category because patients have had stroke – and may have other risk factors, current smoker, obesity * BMI of 30 kg/m² or higher. Age 18 or older Read and speak English or Spanish Access to a telephone Willing to participate in video teleconference group education

V-STOP Intervention 3 individual VT clinic visits with a stroke specialist (MD and NP providers) 3 VT group classes for self-management education and support

Phase 1 2 hub sites delivering to 1 spoke site each Clinician Interviews Focus Group Evaluation Access/Acceptability Stroke Specific Knowledge Patient Outcomes VT Group SM Phase 2 4 hub sites delivering to 2 spoke sites VT Clinic Refine V-STOP Format VT Clinic VT Group SM VT Clinic VT Group SM Methods

Study Startup & Milestones 7/14 -9 /1410/ /141/15 - 3/154/14 - 6/157/15 - 9/15 Hire & Train Staff Hub Sites InitiatedCompleted Site VisitsInitiatedCompleted Study Materials InitiatedCompleted VT EquipmentInitiatedCompleted Contracts w/ Spoke Sites Initiated IRB Approval all Sites InitiatedCompleted RedCap Database Completed Hub Site Training Completed

We Are Here Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Initiate Phase 1 Recruit and enroll patients Initiate intervention Data collection Complete focus groups Data analysis Revise V-STOP II Initiate Phase II Recruit and enroll patients Data collection Statistical analysis Dissemination of findings

Outcomes Describe the Effect of V-STOP Access - AcceptabilityPatient Knowledge Self-management Skills Patient Outcomes BaselineWk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 12 Wk 18 Data CollectionV- STOP Intervention Data Collection

Measures V-STOP Course Evaluation Access/Attendance/Acceptability Telemedicine Satisfaction Questionnaire V-STOP Satisfaction Questionnaire Primary Measures – Stroke Risk Knowledge Test (investigator developed pre/post test) Lorig K et al. Outcome Measures for Health Education and Other Health Care Interventions. Thousand Oaks CA: Sage Publications; 1996) Self-efficacy for Managing Chronic Disease Scale Communication with Health Care Providers Scale Exercise Behaviors Scale Cognitive Symptoms Management Scale Disability Scale Exploratory Measures Biophysical measures BP, A1C, Smoking, BMI, physical activity NINDS-specified Common Data Elements (CDE).

Conclusions We have developed a stroke prevention & patient self- management program and will test this in LSS telemedicine network Aligns with Texas Plan to Reduce Cardiovascular Test implementation strategies that specifically support and reinforce healthy behavior for patients with stroke Test feasibility of linking specialty care resources for stroke with follow-up stroke care in the community through a telehealth network Identify barriers and facilitator strategies for establishing a telehealth systems to deliver stroke secondary prevention to underserved Texas residents Provides preliminary data and established partnerships for grant applications to NIH and other funding agencies

Acknowledgments: Kendall Brown, BSN, RN Yvette Gutierrez, BSN, RN Barbara Kimmel, MS, MSc., CCRP Munachi Okpala, BSN, RN Jacqueline Posey, BSN, RN Betsy Sansom, BSN, RN Pamela Willson, PhD, RN, FNP-BC Marci Wilson, RN Thank you!