Jane A. Anderson PhD, RN, FNP-BC and Thomas A. Kent MDAnjail Sharrief, MD, MPH

Johanna Morton, MDRobin Brey, MD

V-STOP II

Video Teleconference Technology to

Implement Patient Self-management TO Prevent Stroke

V-STOP II & the Texas Plan to Reduce Cardiovascular Disease & Stroke

Goal 1: Strategies that Support/Reinforce Healthy BehaviorGoal 2: Community - Clinical Linkages EnhancementsGoal 3: Health Systems Interventions

The V-STOP-Stroke Program

Stroke Risk Factor

Control

Lifestyle Behavior Change

Clinical Manageme

nt

Therapy / Ischemic Stroke EtiologyThrombotic – Carotid

Intervention/AntiplateletsCardioembolic – 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 VT Clinic

Refine V-STOP Format

VT Clinic VT Group SM VT Group SM

VT Clinic VT Clinic VT Clinic VT Group SMVT Group SM VT Group SM

Methods

Study Startup & Milestones7/14 -9 /14 10/14 - 12/14 1/15 - 3/15 4/14 - 6/15 7/15 - 9/15

Hire & Train Staff Hub Sites

Initiated Completed

Site Visits Initiated Completed

Study Materials

Initiated Completed

VT Equipment Initiated Completed

Contracts w/ Spoke Sites

Initiated

IRB Approval all Sites

Initiated Completed

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 - Acceptability Patient Knowledge Self-management Skills

Patient Outcomes

Baseline Wk 1

Wk 2

Wk3

Wk 4

Wk 5

Wk6

Wk12

Wk18

Data Collection V- STOP Intervention

Data Collection

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).

ConclusionsWe have developed a stroke prevention & patient self-management program and will test this in LSS telemedicine networkAligns with Texas Plan to Reduce Cardiovascular

Test implementation strategies that specifically support and reinforce healthy behavior for patients with strokeTest feasibility of linking specialty care resources for stroke with follow-up stroke care in the community through a telehealth networkIdentify 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!