V-STOP II
Video Teleconference Technology to
Implement Patient Self-management TO Prevent
Stroke
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 & 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
The V-STOP Intervention
Therapy / Ischemic Stroke Etiology
Thrombotic – Carotid
Intervention/Antiplatelets
Cardioembolic – Anticoagulation
HTN, DM, Hyperlipidemia, Obesity
Meet Target Values for
BP – A1c – LDL – BMI
Clinical
Management
Stroke Risk
Factor
Control
Lifestyle Behavior
Change
Patient Education & Self-management
Smoking Cessation - Health Diet - Physical Activity
- Decrease Alcohol Consumption
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
Methods
VT Clinic
VT Group SM
VT Clinic
VT Group SM
VT Clinic
VT Group SM
Phase 1
2 hub sites
delivering
to 1 spoke
site each
Focus Group Evaluation
Clinician Interviews
Refine V-STOP Format
VT Clinic
VT Group SM
VT Clinic
VT Group SM
VT Clinic
Phase 2
4 hub sites
delivering to
2 spoke sites
Access/Acceptability
Stroke Specific Knowledge
Patient Outcomes
VT Group SM
Study Startup & Milestones
Hire & Train
Staff Hub Sites
7/14 -9 /14
10/14 - 12/14
Initiated
Completed
1/15 - 3/15
4/14 - 6/15
Site Visits
Initiated
Study
Materials
Initiated
VT Equipment
Initiated
Completed
Initiated
Completed
Contracts w/
Spoke Sites
IRB Approval
all Sites
7/15 - 9/15
Completed
Completed
Initiated
RedCap
Database
Completed
Hub Site
Training
Completed
We Are Here
Mar
Feb
Jan
Dec
Nov
Oct
Sept
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
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
Describe the Effect of V-STOP
Outcomes
Access - Acceptability
Baseline
Data
Collection
Wk Wk
1
2
Wk
3
Patient Knowledge
Self-management Skills
Wk
4
Wk
5
V- STOP Intervention
Wk
6
Patient Outcomes
Wk
12
Wk
18
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).
Conclusions
We have developed a stroke prevention & patient selfmanagement 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!