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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(05): 883-891
DOI: 10.1055/s-0043-1772679
CIC 2022

Improving Patient-Reported Outcomes in Stroke Care using Remote Blood Pressure Monitoring and Telehealth

Imama A. Naqvi
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
,
Kevin Strobino
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
,
Hanlin Li
2   NewYork-Presbyterian Hospital, New York, New York, United States
,
Kevin Schmitt
2   NewYork-Presbyterian Hospital, New York, New York, United States
,
Yuliya Barratt
2   NewYork-Presbyterian Hospital, New York, New York, United States
,
Stephen A. Ferrara
3   School of Nursing, Columbia University, New York, New York, United States
,
Amna Hasni
4   Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, United States
,
Kenrick D. Cato
5   Department of Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Mark G. Weiner
6   Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
,
Mitchell S. V. Elkind
1   Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
,
Ian M. Kronish
7   Division of Cardiology, Department of Internal Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States
,
Adriana Arcia
8   Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, United States
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Abstract

Background Inequities in health care access leads to suboptimal medication adherence and blood pressure (BP) control. Informatics-based approaches may deliver equitable care and enhance self-management. Patient-reported outcomes (PROs) complement clinical measures to assess the impact of illness on patients' well-being in poststroke care.

Objectives The aim of this study was to determine the feasibility of incorporating PROs into Telehealth After Stroke Care (TASC) and to explore the effect of this team-based remote BP monitoring program on psychological distress and quality of life in an underserved urban setting.

Methods Patients discharged home from a Comprehensive Stroke Center were randomized to TASC or usual care for 3 months. They were provided with a BP monitor and a tablet that wirelessly transmitted data to a cloud-based platform, which were integrated with the electronic health record. Participants who did not complete the tablet surveys were contacted via telephone or e-mail. We collected the Patient-Reported Outcomes Measurement Information System Managing Medications and Treatment (PROMIS-MMT), Patient Activation Measure (PAM), Neuro-QOL (Quality of Life in Neurological Disorders) Cognitive Function, Neuro-QOL Depression, and Patient Health Questionnaire-9 (PHQ-9). T-tests and linear regression were used to evaluate the differences in PRO change between the arms.

Results Of the 50 participants, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanisms of PRO submission for the arms included tablet (62 vs. 47%), phone (24 vs. 37%), tablet with phone coaching (10 vs. 16%), and e-mail (4 vs. 0%). PHQ-9 depressive scores were nominally lower in TASC at 3 months compared with usual care (2.7 ± 3.6 vs. 4.0 ± 4.1; p = 0.06). No significant differences were observed in PROMIS-MMT, PAM, or Neuro-QoL measures.

Conclusion Findings suggest the feasibility of collecting PROs through an interactive web-based platform. The team-based remote BP monitoring demonstrated a favorable impact on patients' well-being. Patients equipped with appropriate resources can engage in poststroke self-care to mitigate inequities in health outcomes.

Keywords

telehealth - PROMIS - PRO change scores - clinical decision support - information systems

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by the TASC Institutional Review Board.




Publication History

Received: 02 March 2023

Accepted: 13 June 2023

Article published online:
08 November 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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