Abstract Details

Patient burden contributes to suboptimal outcomes among underserved populations. In addition to clinical outcomes, PROs can assess the impact of patient illness and associated interventions on perceived well-being. We developed a multidisciplinary team-based model integrated with remote BP monitoring and individualized visual education to improve post-stroke care resulting in substantial BP reduction, especially among Hispanic and non-Hispanic Black patients.

To determine the feasibility of incorporating patient-reported outcomes (PROs) into routine care among Telehealth After Stroke Care (TASC) study participants and to explore the effect of a team-based remote blood pressure (BP) monitoring program on psychological distress, quality of life and health activation.

The study leveraged five survey measures to evaluate PROs in control (n=25) and TASC arms (n=25): Patient Reported Outcomes Measurement Information System (PROMIS) Self Efficacy, Patient Activation Measure (PAM), Neuro-QOL (Quality of Life) Cognition and Depression, and Patient Health Questionnaire-9 (PHQ-9). Data were collected through a tablet provided to patients integrated with the electronic medical record. Patients who did not complete the surveys via tablet were contacted via telephone or e-mail. PROs were evaluated for difference in change over the study course between the two arms using simple linear regression.  

Of the fifty patients, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanism of survey submission included tablet (62% vs 47%), phone (24% vs 37%), tablet/phone combination (10% vs 16%), and e-mail (4% vs 0%), respectively.  There was a trend for reduction in depressive symptoms with PHQ-9 (p=0.06) in TASC arm. No significant differences were observed in PROMIS (p=0.67), PAM (p=0.71), or NeuroQoL measures (p=0.91, p=0.98).

Our findings suggest feasibility of incorporating PROs to rigorously evaluate a quality improvement intervention. It supports the concept of self-management through interactive web-based platforms. Patients equipped with appropriate resources can engage in post-stroke care to mitigate inequities in health outcomes.